Author + information
- Received March 25, 2010
- Revision received June 16, 2010
- Accepted July 17, 2010
- Published online February 8, 2011.
- Philipp Lurz, MD⁎,†,‡,⁎ (, )
- Johannes Nordmeyer, MD⁎,†,§,
- Alessandro Giardini, MD, PhD†,
- Sachin Khambadkone, MD†,
- Vivek Muthurangu, MD⁎,
- Silvia Schievano, PhD⁎,
- Jean-Benoit Thambo, MD†∥,
- Fiona Walker¶,
- Seamus Cullen¶,
- Graham Derrick†,
- Andrew M. Taylor, MD⁎,† and
- Philipp Bonhoeffer, MD⁎
- ↵⁎Reprints requests and correspondence:
Dr. Philipp Lurz, Department of Internal Medicine/Cardiology & Grown Up Congenital Heart Disease, University of Leipzig–Heart Center, Struempellstr. 39, 04289 Leipzig, Germany
Objectives The purpose of this study was to assess the potential of late positive functional remodeling after percutaneous pulmonary valve implantation (PPVI) in right ventricular outflow tract dysfunction.
Background PPVI has been shown to impact acutely on biventricular function and exercise performance, but the potential for further late functional remodeling remains unknown.
Methods Sixty-five patients with sustained hemodynamic effects of PPVI at 1 year were included. Patients were divided into 2 subgroups based on pre-procedural predominant pulmonary stenosis (PS) (n = 35) or predominant pulmonary regurgitation (PR) (n = 30). Data from magnetic resonance imaging and cardiopulmonary exercise testing were compared at 3 time points: before PPVI, within 1 month (early) and at 12 months (late) after PPVI.
Results There was a significant decrease in right ventricle end-diastolic volume early after PPVI in both subgroups of patients. Right ventricle ejection fraction improved early only in the PS group (51 ± 11% vs. 58 ± 11% and 51 ± 12% vs. 50 ± 11%, p < 0.001 for PS, p = 0.13 for PR). Late after intervention, there were no further changes in magnetic resonance parameters in either group (right ventricle ejection fraction, 58 ± 11% in the PS group and 52 ± 11% in the PR group, p = 1.00 and p = 0.13, respectively). In the PS group at cardiopulmonary exercise testing, there was a significant improvement in peak oxygen uptake early (24 ± 8 ml/kg/min vs. 27 ± 9 ml/kg/min, p = 0.008), with no further significant change late (27 ± 9 ml/kg/min, p = 1.00). In the PR group, no significant changes in peak oxygen uptake from early to late could be demonstrated (25 ± 8 ml/kg/min vs. 25 ± 8 ml/kg/min vs. 26 ± 9 ml/kg/min, p = 0.48).
Conclusions In patients with a sustained hemodynamic result 1 year after PPVI, a prolonged phase of maintained cardiac function is observed. However, there is no evidence for further positive functional remodeling beyond the acute effects of PPVI.
- cardiopulmonary exercise testing
- congenital heart disease
- magnetic resonance imaging
- percutaneous pulmonary valve implantation
- right ventricular outflow tract dysfunction
Dr. Bonhoeffer is a consultant to Medtronic and NuMed and has received honoraria and royalties for the device described. Dr. Taylor has received speaker honoraria for Medtronic and has a research agreement with Siemens. All other authors have reported that they have no relationships to disclose. Drs. Lurz and Nordmeyer contributed equally to this work.
- Received March 25, 2010.
- Revision received June 16, 2010.
- Accepted July 17, 2010.
- American College of Cardiology Foundation