HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) 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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Victor Tsang Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Frigiola, A. Articles by de Leval, M. Search for Related Content PubMed Articles by Frigiola, A. Articles by de Leval, M. Related Collections Cardiac - physiology Valve disease

Current approaches to pulmonary regurgitation

^a Great Ormond Street Hospital for Children, London, United Kingdom
^b Policlinico San Donato Milanese, IRCCS, Milano Italy
^c The Heart Hospital, UCLH, London, United Kingdom
^d UCL, Institute of Child Health, London, United Kingdom

Received 5 September 2007; received in revised form 29 April 2008; accepted 30 April 2008.

^_* Corresponding author. Address: Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, United Kingdom. Tel.: +44 2078138106; fax: +44 2078138262. (Email: tsangv{at}gosh.nhs.uk).

Objective: To evaluate the effects on ventricular function and volumes following right ventricular outflow tract reconstruction (RVOTR) with pulmonary homograft replacement (PVR) and percutaneous pulmonary valve implantation (PPVI) for predominant pulmonary regurgitation. This study was not intended to compare the two approaches. Methods: We prospectively examined 25 patients (mean age 21 ± 13 years, 96% tetralogy of Fallot, 1/25 with conduit dysfunction) who had PVR with RVOTR for severe pulmonary regurgitation (PR), and 11 patients (mean age 20 ± 9 years, 64% tetralogy of Fallot, 9/11 with conduit dysfunction) who underwent PPVI for predominant PR. Mean age at primary repair in both groups was 4.3 ± 6.6 years. Magnetic resonance imaging was performed prior to, and 1 year following, interventions. Results: Before procedure, NYHA classification was similar in both groups 2.1 ± 0.5. Following interventions, there was a significant reduction in RV volumes in both groups. In the surgical (PVR) group, RV end-diastolic volume (EDV) decreased from 151 ± 49 to 97 ± 32 ml/m² (p < 0.0001) whereas end-systolic volume (ESV) decreased from 80 ± 43 to 46 ± 23 ml/m² (p < 0.0001). In the PPVI group, RV EDV decreased from 106 ± 27 to 89 ± 25 ml/m² (p = 0.002) and RV ESV from 49 ± 20 to 40 ± 16 ml/m² (p = 0.034). Both groups had a significant improvement in RV (63 ± 20 to 72 ± 16 ml/beat, p = 0.003 (PVR group), 53 ± 14 to 67 ± 16 ml/beat, p = 0.030 (PPVI group)) and LV effective stroke volume (61 ± 18 to 73 ± 16 ml/beat, p = 0.001 (PVR group); 59 ± 24 to 75 ± 16 ml/beat, p = 0.009 (PPVI group)). Conclusions: Following either PVR with RVOTR or PPVI, there was a significant reduction in RV volumes and an improvement in RV function. Importantly, in both groups, LV effective SV increased, and this may be the parameter to judge the benefit of the procedure. These results also support PPVI as an extra dimension in complex RVOT management.

Key Words: Pulmonary regurgitation • Pulmonary homograft • Percutaneous pulmonary valve implantation • Magnetic resonance imaging

This article has been cited by other articles:

				L. Adamson, H. A. Vohra, and M. P. Haw Does pulmonary valve replacement post repair of tetralogy of Fallot improve right ventricular function? Interactive CardioVascular and Thoracic Surgery, September 1, 2009; 9(3): 520 - 527. [Abstract] [Full Text] [PDF]

				P. R. Vouhe Editorial comment Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 581 - 582. [Full Text] [PDF]