Circulation. 2005;112:1189-1197
Published online before print August 15, 2005, doi: 10.1161/CIRCULATIONAHA.104.523266
Published online before print August 15, 2005, doi: 10.1161/CIRCULATIONAHA.104.523266
(Circulation. 2005;112:1189-1197.)
© 2005 American Heart Association, Inc.
Valvular Heart Disease |
Percutaneous Pulmonary Valve Implantation in Humans
Results in 59 Consecutive Patients
From Great Ormond Street Hospital (S.K., L.C., A.T., Y.B., G.D., V.T., J.C., J.D., P.B.); London Cardiac MR Research Group, Division of Imaging Sciences, Kings College and Guy’s Hospital (V.M., S.R.H., R.S.R.); and Heart Hospital (D.P.), London, UK.
Correspondence to Dr Sachin Khambadkone, Consultant Cardiologist, Great Ormond Street Hospital, London WC1N 3JH, UK. E-mail khambs{at}gosh.nhs.uk
Received November 23, 2004; revision received May 8, 2005; accepted May 10, 2005.
Background— Right ventricular outflow tract (RVOT) reconstruction with valved conduits in infancy and childhood leads to reintervention for pulmonary regurgitation and stenosis in later life.
Methods and Results— Patients with pulmonary regurgitation with or without stenosis after repair of congenital heart disease had percutaneous pulmonary valve implantation (PPVI). Mortality, hemodynamic improvement, freedom from explantation, and subjective and objective changes in exercise tolerance were end points. PPVI was performed successfully in 58 patients, 32 male, with a median age of 16 years and median weight of 56 kg. The majority had a variant of tetralogy of Fallot (n=36), or transposition of the great arteries, ventricular septal defect with pulmonary stenosis (n=8). The right ventricular (RV) pressure (64.4±17.2 to 50.4±14 mm Hg, P<0.001), RVOT gradient (33±24.6 to 19.5±15.3, P<0.001), and pulmonary regurgitation (PR) (grade 2 of greater before, none greater than grade 2 after, P<0.001) decreased significantly after PPVI. MRI showed significant reduction in PR fraction (21±13% versus 3±4%, P<0.001) and in RV end-diastolic volume (EDV) (94±28 versus 82±24 mL · beat–1 · m–2, P<0.001) and a significant increase in left ventricular EDV (64±12 versus 71±13 mL · beat–1 · m–2, P=0.005) and effective RV stroke volume (37±7 versus 42±9 mL · beat–1 · m–2, P=0.006) in 28 patients (age 19±8 years). A further 16 subjects, on metabolic exercise testing, showed significant improvement in 
O2max (26±7 versus 29±6 mL · kg–1 · min–1, P<0.001). There was no mortality.
Conclusions— PPVI is feasible at low risk, with quantifiable improvement in MRI-defined ventricular parameters and pulmonary regurgitation, and results in subjective and objective improvement in exercise capacity.
Key Words: regurgitation • pulmonary valve insufficiency • magnetic resonance imaging • exercise testing • catheterization
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