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(Circulation. 2009;119:2995-3001.)
© 2009 American Heart Association, Inc.

Pediatric Cardiology

Comparison of Bare Metal Stenting and Percutaneous Pulmonary Valve Implantation for Treatment of Right Ventricular Outflow Tract Obstruction

Use of an X-Ray/Magnetic Resonance Hybrid Laboratory for Acute Physiological Assessment

Philipp Lurz, MD; Johannes Nordmeyer, MD; Vivek Muthurangu, MD, MRCP; Sachin Khambadkone, MD, MRCP; Graham Derrick, MRCP; Robert Yates, MRCP; Michael Sury, FRCA; Philipp Bonhoeffer, MD; Andrew M. Taylor, MD, FRCP, FRCR

From the UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, Cardiorespiratory Unit (P.L., J.N., V.M., S.K., G.D., R.Y., M.S., P.B., A.M.T.), Department of Anaesthesia (M.S.), and Portex Unit Anaesthesia (M.S.), London, UK.

Correspondence to Andrew M. Taylor, Cardiorespiratory Unit, Great Ormond Street Hospital, Great Ormond St, London WC1N 3JH. E-mail a.taylor{at}ich.ucl.ac.uk

Received November 21, 2008; accepted April 13, 2009.

Background— Treatment of right ventricular outflow tract obstruction is possible with a bare metal stent (BMS), although this treatment causes pulmonary regurgitation. In this study, we assessed the acute physiological effects of BMS versus percutaneous pulmonary valve implantation (PPVI) using an x-ray/magnetic resonance hybrid laboratory.

Methods and Results— Fourteen consecutive children (median age, 12.9 years) with significant right ventricular outflow tract obstruction underwent BMS followed by PPVI. Magnetic resonance imaging (ventricular volumes and function and great vessel blood flow) and hemodynamic assessment (invasive pressure measurements) were performed before BMS, after BMS, and after PPVI; all were performed under general anesthesia in an x-ray/magnetic resonance hybrid laboratory. BMS significantly reduced the ratio of right ventricular to systemic pressure (0.75±0.17% versus 0.41±0.14%; P<0.001) with no further change after PPVI (0.42±0.11; P=1.0). However, BMS resulted in free pulmonary regurgitation (21.3±10.7% versus 41.4±7.5%; P<0.001), which was nearly abolished after PPVI (3.6±5.6%; P<0.001). Effective right ventricular stroke volume (right ventricular stroke volume minus pulmonary regurgitant volume) after BMS remained unchanged (33.8±7.3 versus 32.6±8.7 mL/m²; P=1.0) but was significantly increased after revalvulation with PPVI (41.0±8.0 mL/m²; P=0.004). These improvements after PPVI were accompanied by a significant heart rate reduction (75.5±17.7 bpm after BMS versus 69.0±16.9 bpm after PPVI; P=0.006) at maintained cardiac output (2.5±0.5 versus 2.4±0.5 versus 2.7±0.5 mL · min^–1 · m^–2; P=0.14).

Conclusion— Using an x-ray/magnetic resonance hybrid laboratory, we have demonstrated the superior acute hemodynamic effects of PPVI over BMS in patients with right ventricular outflow tract obstruction.

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CLINICAL PERSPECTIVE

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Circulation: Clinical Summaries
Circulation 2009 119: 2963-2964. [Extract] [Full Text]