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Egbe AC, Jain CC, Abozied O, Burchill LJ, Younis A, Karnakoti S, Ahmed MH, Connolly HM. Differences in Right Heart Function After Pulmonary Valve Replacement in Patients With Pulmonary Valve Stenosis Versus Tetralogy of Fallot. J Am Heart Assoc 2024; 13:e034833. [PMID: 38958134 PMCID: PMC11292774 DOI: 10.1161/jaha.124.034833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND There are limited data about the impact of timing of pulmonary valve replacement (PVR) on right heart reverse remodeling in patients with pulmonary regurgitation following intervention for isolated pulmonary valve stenosis (PS). This study compared differences in postprocedural right heart reverse remodeling after early versus late PVR (defined as PVR before versus after attainment of the conservative consensus criteria proposed by Bokma et al, 2018) in patients with prior intervention for PS, using patients with tetralogy of Fallot as the reference group. METHOD AND RESULTS Right atrial reservoir strain and right ventricular free wall strain was measured at baseline, 1 and 3 years after PVR. There were 114 patients with PS (early PVR, 87 [76%]; late PVR, 27 [24%]) and 291 patients with tetralogy of Fallot (early PVR, 197 [67%]; late PVR, 96 [33%]). The PS group had greater improvement in right atrial reservoir strain at 1 year (12%±4% versus 8%±4%; P<0.001) and 3 years (15%±6% versus 9%±6%; P<0.001), and a greater improvement in right ventricular free wall strain at 1 year (12%±4% versus 7%±3%, P=0.008) and 3-years (16%±6% versus 12%±5%; P=0.01) after PVR compared with the tetralogy of Fallot group. There was no difference in right heart reverse remodeling between patients who underwent early versus later PVR within the PS group. In contrast, late PVR was associated with less right heart reverse remodeling within the tetralogy of Fallot group. CONCLUSIONS These data suggest that patients with palliated PS presenting pulmonary regurgitation have a more benign clinical course, and hence delaying PVR in this population may be appropriate.
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Affiliation(s)
- Alexander C. Egbe
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - C. Charles Jain
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Omar Abozied
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Luke J. Burchill
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Ahmed Younis
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Snigdha Karnakoti
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Marwan H. Ahmed
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Heidi M. Connolly
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
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Işık O, Akyüz M, Mercan İ. Bovine jugular vein conduit replacement after homograft degeneration in patients with tetralogy of Fallot: The results of re-redo cases. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:199-206. [PMID: 37484639 PMCID: PMC10357866 DOI: 10.5606/tgkdc.dergisi.2023.24057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 07/25/2023]
Abstract
Background This study aims to present our experience and results in terms of reconstruction with bovine jugular vein conduit in re-redo patients who developed severe homograft degeneration with pulmonary homograft valve replacement. Methods Between May 2018 and May 2021, a total of 10 re-redo patients (4 males, 6 females; mean age: 16.5±3.0 years; range, 12 to 21 years) who underwent bovine jugular vein conduit replacement due to homograft degeneration were retrospectively analyzed. The clinical, pre-, intra-, and postoperative data of the patients were recorded. Results The mean age of the second operation (homograft replacement) was 8.5±3.8 (range, 4 to 14) years in the patients who underwent homograft replacement. No postoperative mortality was observed. When the pre- and postoperative findings were compared, the right ventricular outflow tract gradient, the degree of pulmonary and tricuspid regurgitation, and right ventricular dilatation were regressed (p<0.05). A significant improvement in the New York Heart Association functional class was observed in all patients after surgery. Conclusion After tetralogy of Fallot corrective surgery, repetitive surgical interventions are inevitable due to pulmonary valve deterioration. Therefore, a bovine jugular vein conduit may be a good alternative for conduit preference after pulmonary homograft failure in re-redo cases.
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Affiliation(s)
- Onur Işık
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Türkiye
| | - Muhammet Akyüz
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Türkiye
| | - İlker Mercan
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Türkiye
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Hufton A, Newman JS, Pupovac SS, Mattia A, Hartman AR. Degenerative Pulmonary Valve Insufficiency in a Patient With a Prior Bentall Procedure. Ann Thorac Surg 2020; 111:e333-e334. [PMID: 33038336 DOI: 10.1016/j.athoracsur.2020.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022]
Abstract
Adult pulmonary valve regurgitation most commonly presents after congenital cardiac surgery, with limited reports of pure degenerative valvular disease. We present a patient who underwent a Bentall procedure for annuloaortic ectasia with severe aortic insufficiency 14 years prior now presenting with degenerative, severe, symptomatic pulmonary valve regurgitation and normal pulmonary pressures. The patient underwent successful valve replacement with a bovine prosthesis. Recovery was unremarkable, and he continues to do well without further cardiac surgical requirements.
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Affiliation(s)
- Austen Hufton
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, New York
| | - Joshua S Newman
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, New York.
| | - Stevan S Pupovac
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, New York
| | - Allan Mattia
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, New York
| | - Alan R Hartman
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, New York
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Egbe AC, Banala K, Vojjini R, Osman K, Afzal A, Jain V, Thotamgari S, Ammash NM. The applications and potential limitations of right ventricular volumes as surrogate marker in tetralogy of fallot. IJC HEART & VASCULATURE 2019; 26:100430. [PMID: 31763442 PMCID: PMC6864123 DOI: 10.1016/j.ijcha.2019.100430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 11/17/2022]
Abstract
Cardiac magnetic resonance imaging derived right ventricular (RV) volumes are often necessary for optimal timing of pulmonary valve replacement in patients with tetralogy of Fallot (TOF). This practice is based on previous studies that reported preoperative RV volumetric thresholds that predicted postoperative RV remodeling. As a result, pulmonary valve replacements are being performed even in asymptomatic patients based on RV volumetric thresholds that predict complete postoperative RVOT remodeling. Hence, RV volumes are now being used as surrogate markers/endpoints for future cardiovascular outcomes. Unfortunately, there are no studies showing survival benefit for performing pulmonary valve replacement at smaller RV volumes. This review underscores some of the limitations of using RV volumes as surrogate markers for clinical outcomes, and also highlights knowledge gaps about the pathophysiologic mechanism of cardiovascular death in the TOF population.
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Affiliation(s)
- Alexander C. Egbe
- Corresponding author at: Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, United States.
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Secchi F, Chessa M, Petrini M, Monti CB, Alì M, Cannaò PM, Di Leo G, Sardanelli F. Pulmonary Insufficiency. J Thorac Imaging 2019; 34:380-386. [DOI: 10.1097/rti.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Egbe AC, Najam M, Banala K, Vojjinni R, Faizan F, Ammash NM, Khalil F, Mathew J, Angirekula M, Connolly HM. Usefulness of Right Ventricular Volumetric and Afterload Indices for Risk Stratification in Patients With Tetralogy of Fallot. Am J Cardiol 2019; 124:1293-1297. [PMID: 31439278 DOI: 10.1016/j.amjcard.2019.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
Right ventricular (RV) volume overload due to chronic pulmonary regurgitation is the common mechanism for hemodynamic deterioration after tetralogy of Fallot (TOF) repair. As a result, RV volumetric indices are used for clinical risk stratification in this population. Since RV afterload is a determinant of RV hemodynamic performance, we hypothesized that afterload-adjusted RV volumetric indices will have a better correlation with disease severity compared with RV volumetric indices alone in patients with TOF. Cross-sectional study of adults with previous TOF repair that received care at Mayo Clinic, 2002-2015. We defined disease severity as atrial arrhythmia and/or impaired exercise capacity. We created afterload-adjusted RV volumetric indices by indexing these indices to RV systolic pressure (RVSP) as follows: RV end-diastolic volume (RVEDVi)/RVSP, RV end-systolic volume (RVESVi)/RVSP, and RV ejection fraction (RVEF)/RVSP. The RV volumetric indices were: RVEDVi 141 ± 43 ml/m2, RVESVi 79 ± 38 ml/m2, and RVEF 44 ± 10%, and RVSP was 48 ± 9 mm Hg. RVESVi was the only RV volumetric parameter that was associated with disease severity (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.01 to 1.32, p = 0.041) with area under the curve (AUC) of 0.612. In contrast RVEF/RVSP (OR 0.73, 95% CI 0.38 to 0.92, p = 0.037, AUC 0.649), and RVESVi/RVSP (OR 1.28, 95% CI 1.14-1.55, p = 0.008, AUC 0.798) were associated with disease severity. Compared with RV volumetric indices alone, the combined RV volumetric and afterload indices had better correlation with disease severity as measured by AUC. Afterload-adjusted RV volumetric indices had better correlation with disease severity, and may potentially improve risk stratification in this population.
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Egbe AC, Miranda WR, Pellikka PA, Pislaru SV, Borlaug BA, Kothapalli S, Ananthaneni S, Sandhyavenu H, Najam M, Farouk Abdelsamid M, Connolly HM. Right ventricular and pulmonary vascular function indices for risk stratification of patients with pulmonary regurgitation. CONGENIT HEART DIS 2019; 14:657-664. [PMID: 30957982 PMCID: PMC6988990 DOI: 10.1111/chd.12768] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/31/2019] [Accepted: 03/07/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND We hypothesized that echocardiographic indices of right ventricular to pulmonary artery (RV-PA) coupling were comparable to cardiac magnetic resonance imaging (CMRI)-derived RV volumetric indices in predicting disease severity in chronic pulmonary regurgitation (PR). METHODS Patients with ≥ moderate PR (2003-2015) with and without prior CMRI scans were enrolled into the study cohort and validation cohort, respectively. Endpoint was to determine the association between noninvasive RV-PA coupling indices (tricuspid annular plane systolic excursion/right ventricular systolic pressure [TAPSE/RVSP] and fractional area change [FAC]/RVSP ratio) and markers of disease severity, and compared this association to that of CMRI-derived RV volumetric indices and markers of disease severity (peak oxygen consumption [VO2 ], NT-proBNP and atrial and/or ventricular arrhythmias). RESULTS Of the 256 patients in the study cohort (age 33 ± 6 years), 187 (73%) had tetralogy of Fallot (TOF) while 69 (27%) had valvular pulmonic stenosis (VPS). TAPSE/RVSP (r = 0.73, P < .001) and FAC/RVSP (r = 0.78, P < .001) correlated with peak VO2 . Among the CMRI-derived RV volumetric indices analyzed, only right ventricular end-systolic volume index correlated with peak VO2 (r = -0.54, P < .001) and NT-proBNP (r = 0.51, P < .001). These RV-PA coupling indices were tested in the validation cohort of 218 patients (age 37 ± 9 years). Similar to the study cohort, TAPSE/RVSP (r = 0.59, P < .001) and FAC/RVSP (r = 0.70, P < .001) correlated with peak VO2 . TAPSE/RVSP (but not FAC/RVSP) was also associated with arrhythmia occurrence in both the study cohort and validation cohorts. CONCLUSION Noninvasive RV-PA coupling may provide complementary prognostic data in the management of chronic PR. Further studies are required to explore this clinical tool.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Srikanth Kothapalli
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Sindhura Ananthaneni
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | | | - Maria Najam
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | | | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota
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Assessment of Right Ventricular-Pulmonary Arterial Coupling in Chronic Pulmonary Regurgitation. Can J Cardiol 2019; 35:914-922. [PMID: 31292091 DOI: 10.1016/j.cjca.2019.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We hypothesized that noninvasively measured right ventricular (RV) to pulmonary arterial (RV-PA) coupling would be abnormal in chronic pulmonary regurgitation (PR) even in the setting of normal RV ejection fraction, and that RV-PA coupling indices would have a better correlation with peak oxygen consumption (VO2) compared with RV systolic indices alone. METHODS This was a retrospective study of 129 adults (repaired tetralogy of Fallot [TOF] n = 84 and valvular pulmonic stenosis [VPS] with previous intervention n = 45) with ≥ moderate native PR and RV ejection fraction > 50%. The 84 TOF patients were propensity matched with 84 patients with normal echocardiogram (control); age 28 ± 7 years and male sex n = 39 (46%). RV-PA coupling was measured according to fractional area change (FAC)/RV systolic pressure (RVSP) and tricuspid annular plane systolic excursion (TAPSE)/RVSP. RESULTS RV systolic function indices were similar between TOF and control groups (FAC 43 ± 6% vs 41 ± 5% [P = 0.164] and TAPSE 22 ± 5 mm vs 24 ± 6 mm [P = 0.263]). However, RV-PA coupling was lower in the TOF group (FAC/RVSP 1.10 ± 0.29 vs 1.48 ± 0.22 [P < 0.001]; TAPSE/RVSP 0.51 ± 0.15 vs 0.78 ± 0.11 [P < 0.001]) because of higher RV afterload (RVSP 42 ± 3 mm Hg vs 31 ± 3 mm Hg [P = 0.012]). FAC/RVSP (r = 0.61; P < 0.001) and TAPSE/RVSP (r = 0.69; P < 0.001) correlated with peak VO2 especially in the patients with impaired exercise capacity whereas FAC and TAPSE were independent of peak VO2. Similar comparisons between VPS and control groups showed no difference in TAPSE and FAC between groups, but lower FAC/RVSP and TAPSE/RVSP in the VPS group. CONCLUSIONS There is abnormal RV-PA coupling in chronic PR, and noninvasively measured RV-PA coupling might potentially be prognostic because of its correlation with exercise capacity.
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Grignola JC, Trujillo P, Domingo E. Pulmonary hypertension associated with left heart disease: efforts to improve the meaning of haemodynamic phenotypes. Eur Respir J 2019; 53:53/3/1801894. [DOI: 10.1183/13993003.01894-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/04/2018] [Indexed: 11/05/2022]
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