Percutaneous Pulmonary Valve Implantation in the Young

Vezmar, Marko; Chaturvedi, Rajiv; Lee, Kyong Jin; Almeida, Claudia; Manlhiot, Cedric; McCrindle, Brian W.; Horlick, Eric; Benson, Lee

doi:10.1016/j.jcin.2010.02.003

Cited by 84 publications

(74 citation statements)

References 34 publications

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“…PPVI leading to restoration of pulmonary valve function, similarly to PVR, simultaneously being a less invasive method, could be expected to have a positive effect on heart function and consequently exercise performance. There is, however, no clear evidence of improvement in cardiopulmonary function after the procedure [11,15,18,20,21]. In our study, a small but significant improvement in peak VO 2 and EQCO 2 were reported.…”

Section: Discussioncontrasting

confidence: 68%

Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?

et al. 2015

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Background: The aim of the study was to evaluate the role of cardiopulmonary exercise testing (CPET) parameters in assessing exercise capacity improvement after percutaneous pulmonary valve implantation (PPVI (25.3 ± 3.3 to 24.3 ± 3.0, p = 0.04) and oxygen consumption at peak exercise (pVO 2 ) (20.4 ± 5.0 to 22.6 ± 5.3 mL/ /kg/min, p = 0.04). Improved EQCO 2 correlated with an increase in right and left ventricular ejection fraction (respectively R = -0.57, p = 0.002; R = -0.56, p = 0.002). In this study, no baseline factors that might affect improvement in exercise function were found. Conclusions: Successful PPVI leads to an improvement in exercise capacity and hemodynamic response to exercise. The correlation between the improvement in EQCO 2 or peak VO 2 and baseline characteristics was too weak to reliably identify the group of patients that will benefit from the procedure. (Cardiol J 2015; 22, 3: 343-350) Key words: percutaneous pulmonary valve implantation, cardiopulmonary exercise testing, grown up congenital heart disease 343

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Section: Discussioncontrasting

confidence: 68%

Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?

et al. 2015

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“…Two-dimensional transthoracic echocardiography was performed on a Phillips IE-33 (Andover, Massachusetts) machine using accepted methods, 2,10 with a standardized clinical protocol performed by a research sonographer. Data were retrieved from clinical reports with missing or outlying data points reviewed by 1 of the authors (S. Borik).…”

Section: Echocardiographymentioning

confidence: 99%

“…Data were retrieved from clinical reports with missing or outlying data points reviewed by 1 of the authors (S. Borik). RV enddiastolic (RVED) dimension and left ventricular (LV) ejection fraction were measured using m-mode in the parasternal short axis cut of the ventricles 2 and RV systolic pressure (RVSp) estimated using continuous wave Doppler from the tricuspid regurgitation jet velocity plus 5 mm Hg. Z-scores were calculated using accepted pediatric values.…”

Section: Echocardiographymentioning

confidence: 99%

“…In this regard, several series have demonstrated favorable short-term outcomes after percutaneous pulmonary valve implantation (PPVI) in the pediatric population. [1][2][3][4][5][6] Whether the timing of valve replacement affects RV remodeling is an unanswered question, with some units advocating early intervention even in the asymptomatic individual to maximize the effects on RV form and function. [7][8][9] This study examines the intermediate-term effect of PPVI on RV size, function, and aerobic exercise capacity and the influence of age at intervention on these variables.…”

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confidence: 99%

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Percutaneous Pulmonary Valve Implantation: 5 Years of Follow-Up

Borik

Crean

Horlick

et al. 2015

Circ: Cardiovascular Interventions

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Background-Percutaneous pulmonary valve implantation (PPVI) is a safe, less invasive alternative to surgical valve replacement for the congenital heart disease patient with right ventricular (RV) outflow tract dysfunction. The aim of this study was to determine whether reverse RV remodeling after PPVI was persistent in the longer term and whether timing of PPVI influenced outcomes. Methods and Results-Consecutive patients from the pediatric and adult congenital heart disease programs were enrolled.Cardiac MRI, echocardiography, metabolic exercise testing, chest radiography, and hemodynamics before intervention were compared with repeated follow-up measurements to assess changes over time. Fifty-one patients (including 23 patients <16 years old) were followed for a mean 4.5±1.9 (0.9-6.9) years after implantation, 59% of patients having available comparative cardiac MRI data. Freedom from any reintervention was 87% and 68% at 3 and 5 years, and freedom from surgery was 90% at 5 years. For every decade younger at implantation, there was an increase of 3.9%±1.0% in cardiac MRI left ventricular ejection fraction (P<0.001) and 2.4±0.9 mL/kg/min in maxVO 2 (P=0.005) and a decrease of 0.7±0.2 cm in RV end-diastolic dimension (P<0.001) after intervention. Younger patients displayed an additional decline in the RV/left ventricular end-diastolic volume ratio (P=0.05) and trended toward improved RV ejection fraction in late follow-up (50%±7% versus 41%±12%, P=0.07). Conclusions-This is the largest series to show that PPVI at a younger age yields incremental improvements in RV size and maximum oxygen consumption. Early valve implantation is associated with better RV function and should be considered in management planning for this population. (Circ Cardiovasc Interv. 2015;8:e001745.

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“…Négy centrumban 36 betegen el végzett percutan beavatkozás után egy évvel a reinter venciómentes-ség 97% volt, egy billentyűt kellett sebé szileg kicserélni [19]. Vezmar és mtsai [20] 28 betegen elvégzett hasonló beavatkozását követően az RVEDV jelentősen csökkent, 36 hónap után a műtétmentesség 83%, az intervenció-mentesség 80% volt.…”

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Right ventricular outflow tract reconstruction in adolescents and adults after previous repair of congenital heart defects

et al. 2012

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A sikeres csecsemő-, gyermekkori beavatkozások eredményeként folyamatosan növekszik azoknak a betegeknek a száma, akik megélik a serdülő-, illetve felnőttkort. Cél: A szerzők a rekonstrukciót követő jobbkamra-kifolyási pálya reoperációinak korai és középtávú eredményeit vizsgálták fi atal-és felnőttkorban. Módszer: 2001 és 2012 között 48, csecsemő-és gyermekkorban rekonstrukciós műtéten átesett (30 Fallot-IV, 11 pulmonalis atresia+kamrai septumdefektus; hat nagyér-transpositio+kamrai septumdefektus+balkamra-kiáramlási szűkület; egy truncus arteriosus) fi atal-és felnőttkori beteg (15-39 év, átlag 21 év) reoperálása történt jobbkamra-diszfunkció, illetve -elégtelenség miatt. Eredmények: Harmincegy betegben a kinőtt homograft, kilenc betegben a transanularis folt helyére homograft, hat betegben a transanularis folttal kialakított anulusba, két betegnél a homograftanulusba biológiai műbillentyű-beül-tetés történt. Tizennégy esetben a műtétet kiterjesztették a jobbkamra-kifolyási pálya aneurysma reszekciójával. Műtét során és a 10 éves utánkövetési periódusban beteget nem vesztettek el. Homograftcserét követően a betegek 95,5%-ában értek el ötéves műtéti beavatkozásmentességet. Következtetések: A jobbkamra-kifolyási pálya rekonstrukciója jó eredménnyel végezhető fi atal-és felnőttkorban. A jobbkamra-elégtelenség megelőzésére javasolt a mű-tét elvégzése már fi atal felnőttkorban, megfelelő szájadék esetén a biológiai műbillentyű beültetése a választandó megoldás. Orv. Hetil., 2012, 153, 1219-1224. Kulcsszavak: jobbkamra-kifolyási pálya rekonstrukciója Right ventricular outfl ow tract reconstruction in adolescents and adults after previous repair of congenital heart defectsDue to successful surgical treatment of congenital heart defects in infants and children, the number of patients who reach the adolescent/adult age is continuously increasing. Aims: The authors sought to identify the short-and medium-term outcomes of reconstruction of right ventricular outfl ow tract in adolescents and adults who underwent surgical intervention for congenital heart defect in infancy or early childhood. Methods: Between 2001 and 2012, 48 patients (age: 15-39, mean 21 years) (30 tetralogy of Fallot, 11 pulmonary atresia + ventricular septal defect, 6 transposition of great arteries + ventricular septal defect + left ventricular outfl ow tract obstruction, and 1 truncus arteriosus) had repeat operation because of right ventricular dysfunction. All patients previously underwent right ventricular outfl ow tract procedures in early childhood. Results: In 31 patients, the small homograft, and in 9 patients the transannular-paths were replaced for "adult-size" homograft. Bioprosthetic pulmonary valve replacement was performed in pulmonary (6 patients) and homograft annuli (2 patients). In 14 patients, resection of the right ventricular outfl ow tract aneurism was also necessary to be performed. There was no early and mid-time (10 years) mortality. In 97.5% of patients with homograft-re-implantation, there was no need for repeat intervention...

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Percutaneous Pulmonary Valve Implantation in the Young

Cited by 84 publications

References 34 publications

Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?

Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?

Percutaneous Pulmonary Valve Implantation: 5 Years of Follow-Up

Right ventricular outflow tract reconstruction in adolescents and adults after previous repair of congenital heart defects

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