This Article Full Text Full Text (PDF) All Versions of this Article: 113/17/2037    most recent CIRCULATIONAHA.105.591438v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Coats, L. Articles by Taylor, A. M. Search for Related Content PubMed PubMed Citation Articles by Coats, L. Articles by Taylor, A. M. Pubmed/NCBI databases Medline Plus Health Information Congenital Heart Defects Related Collections Exercise testing Valvular heart disease Catheter-based coronary and valvular interventions: other CT and MRI Echocardiography Pediatric and congenital heart disease, including cardiovascular surgery Related Article

(Circulation. 2006;113:2037-2044.)
© 2006 American Heart Association, Inc.

Congenital Heart Disease

Physiological and Clinical Consequences of Relief of Right Ventricular Outflow Tract Obstruction Late After Repair of Congenital Heart Defects

Louise Coats, MRCP; Sachin Khambadkone, MD, MRCP; Graham Derrick, MRCP; Shankar Sridharan, MRCP; Silvia Schievano, MEng; Bryan Mist, PhD; Rod Jones, MSc; John E. Deanfield, FRCP; Denis Pellerin, MD, PhD; Philipp Bonhoeffer, MD; Andrew M. Taylor, MD, MRCP, FRCR

From Great Ormond Street Hospital for Children (L.C., S.K., G.D., S. Sridharan, S. Schievano, R.J., J.E.D., P.B., A.M.T.) and The Heart Hospital (B.M., D.P.), London, United Kingdom.

Correspondence to Dr Louise Coats, Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, United Kingdom. E-mail lecoats{at}doctors.org.uk

Received October 12, 2005; revision received January 18, 2006; accepted February 21, 2006.

Background— 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.

Methods and Results— 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.

Conclusions— 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.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2006 113: 2031. [Full Text]

This article has been cited by other articles:

				J. Rodes-Cabau, C. Houde, J. Perron, L. N. Benson, and P. Pibarot Delayed improvement in valve hemodynamic performance after percutaneous pulmonary valve implantation. Ann. Thorac. Surg., May 1, 2008; 85(5): 1787 - 1788. [Abstract] [Full Text] [PDF]

				J. F. Rhodes, Z. M. Hijazi, and R. J. Sommer Pathophysiology of Congenital Heart Disease in the Adult, Part II: Simple Obstructive Lesions Circulation, March 4, 2008; 117(9): 1228 - 1237. [Full Text] [PDF]

				J. Nordmeyer, L. Coats, P. Lurz, T.-Y. Lee, G. Derrick, P. Rees, S. Cullen, A. M. Taylor, S. Khambadkone, and P. Bonhoeffer Percutaneous pulmonary valve-in-valve implantation: a successful treatment concept for early device failure Eur. Heart J., March 3, 2008; (2008) ehn073v1. [Abstract] [Full Text] [PDF]

				E. Bedard, D. F. Shore, and M. A. Gatzoulis Adult congenital heart disease: a 2008 overview Br. Med. Bull., March 1, 2008; 85(1): 151 - 180. [Abstract] [Full Text] [PDF]

				T. Feldman and M. B. Leon Prospects for Percutaneous Valve Therapies Circulation, December 11, 2007; 116(24): 2866 - 2877. [Full Text] [PDF]

				L. Coats, S. Khambadkone, G. Derrick, M. Hughes, R. Jones, B. Mist, D. Pellerin, J. Marek, J. E. Deanfield, P. Bonhoeffer, et al. Physiological consequences of percutaneous pulmonary valve implantation: the different behaviour of volume- and pressure-overloaded ventricles Eur. Heart J., August 1, 2007; 28(15): 1886 - 1893. [Abstract] [Full Text] [PDF]

				T. P. Graham Jr The Year in Congenital Heart Disease J. Am. Coll. Cardiol., July 24, 2007; 50(4): 368 - 377. [Full Text] [PDF]

				I. Inglessis and M. J. Landzberg Interventional Catheterization in Adult Congenital Heart Disease Circulation, March 27, 2007; 115(12): 1622 - 1633. [Full Text] [PDF]