Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects
Right ventricular outflow tract obstruction (RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation (PPVI) can treat this condition without consequent pulmonary regurgitation or cardiopulmonary bypass. Our aim was to investigate the clinical an...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2006-05, Vol.113 (17), p.2037-2044 |
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| creator | COATS, Louise KHAMBADKONE, Sachin TAYLOR, Andrew M DERRICK, Graham SRIDHARAN, Shankar SCHIEVANO, Silvia MIST, Bryan JONES, Rod DEANFIELD, John E PELLERIN, Denis BONHOEFFER, Philipp |
| description | Right ventricular outflow tract obstruction (RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation (PPVI) can treat this condition without consequent pulmonary regurgitation or cardiopulmonary bypass. Our aim was to investigate the clinical and physiological response to relieving RVOTO.
We studied 18 patients who underwent PPVI for RVOTO (72% male, median age 20 years) from a total of 93 who had this procedure for various indications. All had a right ventricular outflow tract (RVOT) gradient >50 mm Hg on echocardiography without important pulmonary regurgitation (less than mild or regurgitant fraction |
| doi_str_mv | 10.1161/CIRCULATIONAHA.105.591438 |
| format | Article |
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We studied 18 patients who underwent PPVI for RVOTO (72% male, median age 20 years) from a total of 93 who had this procedure for various indications. All had a right ventricular outflow tract (RVOT) gradient >50 mm Hg on echocardiography without important pulmonary regurgitation (less than mild or regurgitant fraction <10% on magnetic resonance imaging [MRI]). Cardiopulmonary exercise testing, tissue Doppler echocardiography, and MRI were performed before and within 50 days of PPVI. PPVI reduced RVOT gradient (51.4 to 21.7 mm Hg, P<0.001) and right ventricular systolic pressure (72.8 to 47.3 mm Hg, P<0.001) at catheterization. Symptoms and aerobic (25.7 to 28.9 mL.kg(-1).min(-1), P=0.002) and anaerobic (14.4 to 16.2 mL.kg(-1).min(-1), P=0.002) exercise capacity improved. Myocardial systolic velocity improved acutely (tricuspid 4.8 to 5.3 cm/s, P=0.05; mitral 4.7 to 5.5 cm/s, P=0.01), whereas isovolumic acceleration was unchanged. The tricuspid annular velocity was not maintained on intermediate follow-up. Right ventricular end-diastolic volume (99.9 to 89.7 mL/m2, P<0.001) fell, whereas effective stroke volume (43.7 to 48.3 mL/m2, P=0.06) and ejection fraction (48.0% to 56.8%, P=0.01) increased. Left ventricular end-diastolic volume (72.5 to 77.4 mL/m2, P=0.145), stroke volume (45.3 to 50.6 mL/m2, P=0.02), and ejection fraction (62.6% to 65.8%, P=0.03) increased.
PPVI relieves RVOTO, which leads to an early improvement in biventricular performance. Furthermore, it reduces symptoms and improves exercise tolerance. These findings have important implications for the management of this increasingly common condition.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.105.591438</identifier><identifier>PMID: 16636174</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Adult ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Pressure ; Cardiology. Vascular system ; Child ; Diseases of the aorta ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Echocardiography, Doppler ; Exercise Test ; Female ; Heart Defects, Congenital - surgery ; Heart Valve Prosthesis Implantation - methods ; Humans ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Pulmonary Valve - surgery ; Stents ; Tobacco, tobacco smoking ; Toxicology ; Ventricular Function, Left ; Ventricular Outflow Obstruction - surgery</subject><ispartof>Circulation (New York, N.Y.), 2006-05, Vol.113 (17), p.2037-2044</ispartof><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-fb5aa1081c7b5ab306e77491355e8ee1b8c9863648c60229a4e39902e5d3e9ad3</citedby><cites>FETCH-LOGICAL-c439t-fb5aa1081c7b5ab306e77491355e8ee1b8c9863648c60229a4e39902e5d3e9ad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17755233$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16636174$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>COATS, Louise</creatorcontrib><creatorcontrib>KHAMBADKONE, Sachin</creatorcontrib><creatorcontrib>TAYLOR, Andrew M</creatorcontrib><creatorcontrib>DERRICK, Graham</creatorcontrib><creatorcontrib>SRIDHARAN, Shankar</creatorcontrib><creatorcontrib>SCHIEVANO, Silvia</creatorcontrib><creatorcontrib>MIST, Bryan</creatorcontrib><creatorcontrib>JONES, Rod</creatorcontrib><creatorcontrib>DEANFIELD, John E</creatorcontrib><creatorcontrib>PELLERIN, Denis</creatorcontrib><creatorcontrib>BONHOEFFER, Philipp</creatorcontrib><title>Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Right ventricular outflow tract obstruction (RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation (PPVI) can treat this condition without consequent pulmonary regurgitation or cardiopulmonary bypass. Our aim was to investigate the clinical and physiological response to relieving RVOTO.
We studied 18 patients who underwent PPVI for RVOTO (72% male, median age 20 years) from a total of 93 who had this procedure for various indications. All had a right ventricular outflow tract (RVOT) gradient >50 mm Hg on echocardiography without important pulmonary regurgitation (less than mild or regurgitant fraction <10% on magnetic resonance imaging [MRI]). Cardiopulmonary exercise testing, tissue Doppler echocardiography, and MRI were performed before and within 50 days of PPVI. PPVI reduced RVOT gradient (51.4 to 21.7 mm Hg, P<0.001) and right ventricular systolic pressure (72.8 to 47.3 mm Hg, P<0.001) at catheterization. Symptoms and aerobic (25.7 to 28.9 mL.kg(-1).min(-1), P=0.002) and anaerobic (14.4 to 16.2 mL.kg(-1).min(-1), P=0.002) exercise capacity improved. Myocardial systolic velocity improved acutely (tricuspid 4.8 to 5.3 cm/s, P=0.05; mitral 4.7 to 5.5 cm/s, P=0.01), whereas isovolumic acceleration was unchanged. The tricuspid annular velocity was not maintained on intermediate follow-up. Right ventricular end-diastolic volume (99.9 to 89.7 mL/m2, P<0.001) fell, whereas effective stroke volume (43.7 to 48.3 mL/m2, P=0.06) and ejection fraction (48.0% to 56.8%, P=0.01) increased. Left ventricular end-diastolic volume (72.5 to 77.4 mL/m2, P=0.145), stroke volume (45.3 to 50.6 mL/m2, P=0.02), and ejection fraction (62.6% to 65.8%, P=0.03) increased.
PPVI relieves RVOTO, which leads to an early improvement in biventricular performance. Furthermore, it reduces symptoms and improves exercise tolerance. These findings have important implications for the management of this increasingly common condition.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure</subject><subject>Cardiology. Vascular system</subject><subject>Child</subject><subject>Diseases of the aorta</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Echocardiography, Doppler</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pulmonary Valve - surgery</subject><subject>Stents</subject><subject>Tobacco, tobacco smoking</subject><subject>Toxicology</subject><subject>Ventricular Function, Left</subject><subject>Ventricular Outflow Obstruction - surgery</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkc9uGyEQxlHVqnHTvkJFD-1tXVgWWI6W1TaWrKaqkvOKZQebCoMLbKq8RJ45JLYU9cQM-s03fz6EPlGypFTQr-vN7_XtdnWzuf65ulotKeFLrmjH-ldoQXnbNR1n6jVaEEJUI1nbXqB3Of-pqWCSv0UXVAgmqOwW6OHX_j676OPOGe2xDhM23oXnxMSQ4e8MwUDG0eIE3oF9jtxuX_AdhJKcmb1OOM7F-vgPl6RNwXHMJc2muBiw1wWwtgVSFThql54EqvQOgiu1yx50KngCC6bk9-iN1T7Dh_N7iW6_f7tZXzXb6x-b9WrbmI6p0tiRa01JT42s0ciIACk7RRnn0APQsTeqryt2vRGkbZXugClFWuATA6Undom-nHSPKdYNcxkOLhvwXgeIcx6EVC0TvK2gOoEmxZwT2OGY3EGn-4GS4cmM4X8z6jcfTmbU2o_nJvN4gOml8nz9Cnw-AzrXg9ukg3H5hZOS1xEYewSrFJem</recordid><startdate>20060502</startdate><enddate>20060502</enddate><creator>COATS, Louise</creator><creator>KHAMBADKONE, Sachin</creator><creator>TAYLOR, Andrew M</creator><creator>DERRICK, Graham</creator><creator>SRIDHARAN, Shankar</creator><creator>SCHIEVANO, Silvia</creator><creator>MIST, Bryan</creator><creator>JONES, Rod</creator><creator>DEANFIELD, John E</creator><creator>PELLERIN, Denis</creator><creator>BONHOEFFER, Philipp</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20060502</creationdate><title>Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects</title><author>COATS, Louise ; KHAMBADKONE, Sachin ; TAYLOR, Andrew M ; DERRICK, Graham ; SRIDHARAN, Shankar ; SCHIEVANO, Silvia ; MIST, Bryan ; JONES, Rod ; DEANFIELD, John E ; PELLERIN, Denis ; BONHOEFFER, Philipp</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-fb5aa1081c7b5ab306e77491355e8ee1b8c9863648c60229a4e39902e5d3e9ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure</topic><topic>Cardiology. Vascular system</topic><topic>Child</topic><topic>Diseases of the aorta</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Echocardiography, Doppler</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pulmonary Valve - surgery</topic><topic>Stents</topic><topic>Tobacco, tobacco smoking</topic><topic>Toxicology</topic><topic>Ventricular Function, Left</topic><topic>Ventricular Outflow Obstruction - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>COATS, Louise</creatorcontrib><creatorcontrib>KHAMBADKONE, Sachin</creatorcontrib><creatorcontrib>TAYLOR, Andrew M</creatorcontrib><creatorcontrib>DERRICK, Graham</creatorcontrib><creatorcontrib>SRIDHARAN, Shankar</creatorcontrib><creatorcontrib>SCHIEVANO, Silvia</creatorcontrib><creatorcontrib>MIST, Bryan</creatorcontrib><creatorcontrib>JONES, Rod</creatorcontrib><creatorcontrib>DEANFIELD, John E</creatorcontrib><creatorcontrib>PELLERIN, Denis</creatorcontrib><creatorcontrib>BONHOEFFER, Philipp</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>COATS, Louise</au><au>KHAMBADKONE, Sachin</au><au>TAYLOR, Andrew M</au><au>DERRICK, Graham</au><au>SRIDHARAN, Shankar</au><au>SCHIEVANO, Silvia</au><au>MIST, Bryan</au><au>JONES, Rod</au><au>DEANFIELD, John E</au><au>PELLERIN, Denis</au><au>BONHOEFFER, Philipp</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2006-05-02</date><risdate>2006</risdate><volume>113</volume><issue>17</issue><spage>2037</spage><epage>2044</epage><pages>2037-2044</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Right ventricular outflow tract obstruction (RVOTO) is a common problem after repair of congenital heart disease. Percutaneous pulmonary valve implantation (PPVI) can treat this condition without consequent pulmonary regurgitation or cardiopulmonary bypass. Our aim was to investigate the clinical and physiological response to relieving RVOTO.
We studied 18 patients who underwent PPVI for RVOTO (72% male, median age 20 years) from a total of 93 who had this procedure for various indications. All had a right ventricular outflow tract (RVOT) gradient >50 mm Hg on echocardiography without important pulmonary regurgitation (less than mild or regurgitant fraction <10% on magnetic resonance imaging [MRI]). Cardiopulmonary exercise testing, tissue Doppler echocardiography, and MRI were performed before and within 50 days of PPVI. PPVI reduced RVOT gradient (51.4 to 21.7 mm Hg, P<0.001) and right ventricular systolic pressure (72.8 to 47.3 mm Hg, P<0.001) at catheterization. Symptoms and aerobic (25.7 to 28.9 mL.kg(-1).min(-1), P=0.002) and anaerobic (14.4 to 16.2 mL.kg(-1).min(-1), P=0.002) exercise capacity improved. Myocardial systolic velocity improved acutely (tricuspid 4.8 to 5.3 cm/s, P=0.05; mitral 4.7 to 5.5 cm/s, P=0.01), whereas isovolumic acceleration was unchanged. The tricuspid annular velocity was not maintained on intermediate follow-up. Right ventricular end-diastolic volume (99.9 to 89.7 mL/m2, P<0.001) fell, whereas effective stroke volume (43.7 to 48.3 mL/m2, P=0.06) and ejection fraction (48.0% to 56.8%, P=0.01) increased. Left ventricular end-diastolic volume (72.5 to 77.4 mL/m2, P=0.145), stroke volume (45.3 to 50.6 mL/m2, P=0.02), and ejection fraction (62.6% to 65.8%, P=0.03) increased.
PPVI relieves RVOTO, which leads to an early improvement in biventricular performance. Furthermore, it reduces symptoms and improves exercise tolerance. These findings have important implications for the management of this increasingly common condition.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>16636174</pmid><doi>10.1161/CIRCULATIONAHA.105.591438</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Adolescent Adult Biological and medical sciences Blood and lymphatic vessels Blood Pressure Cardiology. Vascular system Child Diseases of the aorta Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Echocardiography, Doppler Exercise Test Female Heart Defects, Congenital - surgery Heart Valve Prosthesis Implantation - methods Humans Magnetic Resonance Imaging Male Medical sciences Middle Aged Pulmonary Valve - surgery Stents Tobacco, tobacco smoking Toxicology Ventricular Function, Left Ventricular Outflow Obstruction - surgery |
| title | Physiological and clinical consequences of relief of right ventricular outflow tract obstruction late after repair of congenital heart defects |
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