Abstract 2680: Maintained Improvement in Maximal Exercise and Continued Improvement in Sub-Maximal Exercise Indices are Seen During Follow-Up after Percutaneous Pulmonary Valve Insertion
Background: Percutaneous Pulmonary Valve Insertion (PPVI) is available for the treatment of residual pulmonary incompetence or stenosis after repair of congenital heart disease.
Methods: 69 patients, (40 male, median age 19.4y, range 9.9–58.5yrs ), were studied. Echocardiography was performed prior to PPVI. Patients were divided into predominantly pulmonary stenosis (PS), or regurgitation (PR) based on echocardiographic criteria (PS - Right ventricular outflow tract Doppler velocity >3.5 m/s, PR - >grade 2 on Doppler colour flow mapping respectively). Maximal cardiopulmonary exercise testing (CPET) was performed prior to and soon after (median 15 days, range 2–97days) PPVI. A subgroup of 29 patients, (17 male, median age 22 yrs, range 9.9 to 53.4yrs) were restudied a median of 1.1 years ( 0.5 to 1.93yrs ) later.
Results: All patients (N=69) showed improvements in maximal exercise indices (peak oxygen consumption - Peak VO2 Mean±SD 24.6±7.7 - 25.6±7.0 ml/kg/min, p<0.05) and submaximal exercise indices (ventilatory equivalent for carbon dioxide at anaerobic threshold - VE/VCO2 36±7.3 - 34±5.9, p<0.005) acutely after PPVI. The smaller subgroup (N=29) studied at median 1.1yrs after PPVI showed no further improvement in peak VO2 compared to acutely after PPVI testing. However, further improvement in submaximal indices were seen between acutely after post PPVI and later follow up (VE/VCO2 35.1±7.0 -33.2±5.3, p<0.05), most marked in the PR group (37.6±9.4 - 34.5±7.2, p=0.051).
Conclusion: Improvements in maximal exercise capacity are maintained during follow up at median 1.1 years after PPVI . Continued improvements in submaximal indices of exercise performance are seen, especially in patients treated for predominantly PR. This adaptation may be related to continued ventricular remodelling.