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Yin X, Wang Y. Effect of pulmonary regurgitation on cardiac functions based on a human bi-ventricle model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 238:107600. [PMID: 37285726 DOI: 10.1016/j.cmpb.2023.107600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Assessing the severity of pulmonary regurgitation (PR) and identifying optimal clinically relevant indicators for its treatment is crucial, yet standards for quantifying PR remain unclear in clinical practice. Computational modelling of the heart is in the process of providing valuable insights and information for cardiovascular physiology research. However, the advancements of finite element computational models have not been widely applied to simulate cardiac outputs in patients with PR. Furthermore, a computational model that incorporates both the left ventricle (LV) and right ventricle (RV) can be valuable in assessing the relationship between left and right ventricular morphometry and septal motion in PR patients. To enhance our understanding of the effect of PR on cardiac functions and mechanical behaviour, we developed a human bi-ventricle model to simulate five cases with varying degrees of PR severity. METHODS This bi-ventricle model was built using a patient-specific geometry and a widely used myofibre architecture. The myocardial material properties were described by a hyperelastic passive constitutive law and a modified time-varying elastance active tension model. To simulate realistic cardiac functions and the dysfunction of the pulmonary valve in PR disease cases, open-loop lumped parameter models representing systemic and pulmonary circulatory systems were designed. RESULTS In the baseline case, pressures in the aorta and main pulmonary artery and ejection fractions of both the LV and RV were within normal physiological ranges reported in the literature. The end-diastolic volume (EDV) of the RV under varying degrees of PR was comparable to the reported cardiac magnetic resonance imaging data. Moreover, RV dilation and interventricular septum motion from the baseline to the PR cases were clearly observed through the long-axis and short-axis views of the bi-ventricle geometry. The RV EDV in the severe PR case increased by 50.3% compared to the baseline case, while the LV EDV decreased by 18.1%. The motion of the interventricular septum was consistent with the literature. Furthermore, ejection fractions of both the LV and RV decreased as PR became severe, with LV ejection fraction decreasing from 60.5% at baseline to 56.3% in the severe case and RV ejection fraction decreasing from 51.8% to 46.8%. Additionally, the average myofibre stress of the RV wall at end-diastole significantly increased due to PR, from 2.7±12.1 kPa at baseline to 10.9±26.5 kPa in the severe case. The average myofibre stress of the LV wall at end-diastole increased from 3.7±18.1 kPa to 4.3±20.3 kPa. CONCLUSIONS This study established a foundation for the computational modelling of PR. The simulated results showed that severe PR leads to reduced cardiac outputs in both the LV and RV, clearly observable septum motion, and a significant increase in the average myofibre stress in the RV wall. These findings demonstrate the potential of the model for further exploration of PR.
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Affiliation(s)
- Xueqing Yin
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Yingjie Wang
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom.
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Shah SS, Mohanty S, Karande T, Maheshwari S, Kulkarni S, Saxena A. Guidelines for physical activity in children with heart disease. Ann Pediatr Cardiol 2022; 15:467-488. [PMID: 37152503 PMCID: PMC10158469 DOI: 10.4103/apc.apc_73_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/05/2022] [Accepted: 11/20/2022] [Indexed: 03/03/2023] Open
Abstract
Justification In recent years, there has been increasing recognition of children with heart disease in our country. These children belong to different age groups and have untreated, partially treated, or completely treated heart disease. The role of physical activity for optimal physical, emotional, and psychosocial well-being for children is well understood. There is a challenge for the parents and the medical professionals to take a decision regarding the type of physical activity safe for the child as heart disease may affect the hemodynamic demands. Most of the existing international guidelines focus on competitive sports in operated heart disease children. This may be of limited use when we have a mixed population of children with heart disease, different types of sports in our country and where a larger subset is looking for recommendations to leisure time activities. Process The Pediatric Cardiac Society of India decided to formulate recommendations for physical activity in children with heart diseases. A committee of experts, who were well-versed with the subject of physical activity in children with heart disease, volunteered to take up the task of writing the guidelines. The recommendations emerged following deliberations of the committee members, on the virtual platform as well as mails. The final version of manuscript was approved by all committee members and all members are co-authors of this manuscript. The different types of physical activities were defined including leisure sports and competitive sports. The exercise was classified based on the mechanical action of muscles involved into dynamic and static components. Each type of exercise was then classified based on the intensity into low, medium, and high. Recommendations for the type of physical activity for individual heart lesions were decided based on the rationale available. Objectives The recommendations here are made with an intention to provide general guidelines for physical activity in children with operated and unoperated heart diseases, not excluding a need for individualizing a plan, serial assessment, and comprehensive checkup in special situations. Recommendations We hope the recommendations mentioned below would provide basic clarity in planning physical activity in children with heart disease. This is with the hope to encourage physically active life, at the same time ensuring a safety net.
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Affiliation(s)
- Sejal Suresh Shah
- Department of Pediatric Cardiology, Hands on Heart, RxDx Healthcare, Bengaluru, Karnataka, India
| | - Sweta Mohanty
- Department of Pediatric Cardiology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Tanuja Karande
- Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Sunita Maheshwari
- Department of Pediatric Cardiology, Hands on Heart, RxDx Healthcare, Bengaluru, Karnataka, India
| | - Snehal Kulkarni
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Hospital, Navi Mumbai, Maharashtra, India
| | - Anita Saxena
- Department of Cardiology, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
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Arunamata A, Goldstein BH. Right ventricular outflow tract anomalies: Neonatal interventions and outcomes. Semin Perinatol 2022; 46:151583. [PMID: 35422353 DOI: 10.1016/j.semperi.2022.151583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Right ventricular outflow tract (RVOT) anomalies comprise a wide spectrum of congenital heart disease, typically characterized by obstruction to flow from the right ventricle to pulmonary arteries. This review highlights important considerations surrounding management strategy as well as clinical outcomes for the neonate with RVOT anomaly, including: pulmonary atresia with intact ventricular septum, congenital pulmonary valve stenosis, tetralogy of Fallot, and Ebstein anomaly with anatomic or physiologic RVOT obstruction.
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Affiliation(s)
- Alisa Arunamata
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine.
| | - Bryan H Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine
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Huamán-Benancio G, Peralta-Ponce C, Vinelli-Arzubiaga D, Esquivel-León C, Padilla IP. [Outcomes of percutaneous balloon pulmonary valvuloplasty in pulmonary valve stenosis in the pediatric population in a single center, Lima - Peru]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:60-68. [PMID: 37351308 PMCID: PMC10284577 DOI: 10.47487/apcyccv.v3i2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/26/2022] [Indexed: 06/24/2023]
Abstract
Objective To evaluate the effectiveness of the procedure and outcomes during follow-up. Methods 80 patients with pulmonary valvular stenosis who underwent percutaneous balloon valvuloplasty between January 2014 and December 2019 are described. Demographic, echocardiographic, and hemodynamic characteristics of the procedure were evaluated. Follow-up included clinical, echocardiographic parameters, pulmonary regurgitation severity, and residual pulmonary gradient at each cutoff point. Results The age range was 2 years (interquartile range: 10.5 months - 6 years), and the predominant sex was male with 56.2%. The transvalvular pulmonary gradient decreased from 61.7 mmHg +- 21.2 to 17 mmHg (interquartile range: 11-26 mmHg). The immediate success rate was 90%. Follow-up time showed a median of 21 months (interquartile range: 5-47.5 months). All patients at follow-up showed some degree of pulmonary insufficiency at each cutoff point; 17% of the cases at the end of their follow-up were found to have severe insufficiency. Three cases of long-term restenosis were found (3.8%), and 6 (7.5%) were admitted for valvuloplasty surgery or pulmonary valve replacement. The complications reported reached 10% of cases, two patients were admitted to surgery during the procedure for major complications. A significant association was found with severe pulmonary insufficiency at the end of follow-up and ring/balloon ratio. Conclusions Percutaneous transluminal valvuloplasty with balloon is an effective technique in the treatment of pulmonary valvular stenosis, with reported complications but with good results during follow-up.
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Affiliation(s)
- Gian Huamán-Benancio
- Servicio clínico de Cardiología Pediátrica, Instituto Nacional Cardiovascular - INCOR, EsSalud. Lima, Perú. Servicio clínico de Cardiología Pediátrica Instituto Nacional Cardiovascular - INCOR, EsSalud Lima Perú
| | - Carlos Peralta-Ponce
- Servicio clínico de Cardiología Pediátrica, Instituto Nacional Cardiovascular - INCOR, EsSalud. Lima, Perú. Servicio clínico de Cardiología Pediátrica Instituto Nacional Cardiovascular - INCOR, EsSalud Lima Perú
| | - Daniella Vinelli-Arzubiaga
- . Facultad de Medicina, Universidad Ricardo Palma.. Lima, Perú Universidad Ricardo Palma Facultad de Medicina Universidad Ricardo Palma. Lima Peru
| | - Cesar Esquivel-León
- . Servicio clínico de Cardiología Pediátrica, Hospital Luis Albecht, EsSalud. Trujillo, Perú. Servicio clínico de Cardiología Pediátrica Hospital Luis Albecht, EsSalud Trujillo Perú
| | - Isabel Pinedo Padilla
- . Servicio de Endocrinología Hospital Carrión, MINSA. Lima, Perú. Servicio de Endocrinología Hospital Carrión MINSA Lima Perú
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Yin D, Wu X, Xiang P, Zhang Y, Tian J, Lv T, Yi Q, Li M. Outcomes of percutaneous balloon pulmonary valvuloplasty in congenital pulmonary valve stenosis. Clin Case Rep 2021; 9:e04705. [PMID: 34484754 PMCID: PMC8405432 DOI: 10.1002/ccr3.4705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/30/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Percutaneous balloon pulmonary valvuloplasty (PBPV) is the primary treatment for pulmonary valve stenosis (PVS). The study consisted of 228 children with PVS who underwent PBPV from January 2004 to October 2019 at a single center. The risk factors for ≥moderate pulmonary regurgitation (PR), residual stenosis, and restenosis were analyzed based on the baseline patient characteristics and measured value of corresponding inspection results. Among 228 patients, follow-up results were obtained in 193 patients. The univariate analysis demonstrated that young age, low weight, small pulmonary annulus diameter, higher initial RV-PA PSEG, increased RV/systemic pressure ratio, and severe PVS were associated with ≥moderate PR. The multivariate analysis demonstrated that higher initial RV-PA PSEG and low weight were independently associated with ≥moderate PR, while higher initial RV-PA PSEG was independently associated with residual stenosis and restenosis. PBPV is a preferred tre atment in PVS children with a higher success rate. Higher initial RV-PA PSEG was a significant factor for ≥moderate PR, residual stenosis, and restenosis.
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Affiliation(s)
- Dan Yin
- Ministry of Education Key Laboratory of Child Development and DisordersChongqingChina
- Department of Cardiovascular MedicineChildren’s Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of PediatricsChongqingChina
| | - Xiaoyun Wu
- Ministry of Education Key Laboratory of Child Development and DisordersChongqingChina
- Department of Cardiovascular MedicineChildren’s Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of PediatricsChongqingChina
- National Clinical Research Center for Child Health and DisordersChongqingChina
- China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqingChina
| | - Ping Xiang
- Ministry of Education Key Laboratory of Child Development and DisordersChongqingChina
- Department of Cardiovascular MedicineChildren’s Hospital of Chongqing Medical UniversityChongqingChina
- National Clinical Research Center for Child Health and DisordersChongqingChina
- China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqingChina
| | - Yu Zhang
- Ministry of Education Key Laboratory of Child Development and DisordersChongqingChina
- Department of Cardiovascular MedicineChildren’s Hospital of Chongqing Medical UniversityChongqingChina
| | - Jie Tian
- Ministry of Education Key Laboratory of Child Development and DisordersChongqingChina
- Department of Cardiovascular MedicineChildren’s Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of PediatricsChongqingChina
- National Clinical Research Center for Child Health and DisordersChongqingChina
- China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqingChina
| | - Tiewei Lv
- Ministry of Education Key Laboratory of Child Development and DisordersChongqingChina
- Department of Cardiovascular MedicineChildren’s Hospital of Chongqing Medical UniversityChongqingChina
- National Clinical Research Center for Child Health and DisordersChongqingChina
- China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqingChina
| | - Qijian Yi
- Ministry of Education Key Laboratory of Child Development and DisordersChongqingChina
- Department of Cardiovascular MedicineChildren’s Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of PediatricsChongqingChina
- National Clinical Research Center for Child Health and DisordersChongqingChina
- China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqingChina
| | - Mi Li
- Ministry of Education Key Laboratory of Child Development and DisordersChongqingChina
- Department of Cardiovascular MedicineChildren’s Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of PediatricsChongqingChina
- National Clinical Research Center for Child Health and DisordersChongqingChina
- China International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqingChina
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Semilunar Valve Interventions for Congenital Heart Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:71-79. [PMID: 33413944 DOI: 10.1016/j.jacc.2020.10.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023]
Abstract
Transcatheter balloon valvuloplasty for the treatment of aortic and pulmonary valve stenosis was first described nearly 40 years ago. Since that time, the technique has been refined in an effort to optimize acute outcomes while reducing the long-term need for reintervention and valve replacement. Balloon pulmonary valvuloplasty is considered first-line therapy for pulmonary valve stenosis and generally results in successful relief of valvar obstruction. Larger balloon to annulus (BAR) diameter ratios can increase the risk for significant valvar regurgitation. However, the development of regurgitation resulting in right ventricular dilation and dysfunction necessitating pulmonary valve replacement is uncommon in long-term follow-up. Balloon aortic valvuloplasty has generally been the first-line therapy for aortic valve stenosis, although some contemporary studies have documented improved outcomes following surgical valvuloplasty in a subset of patients who achieve tri-leaflet valve morphology following surgical repair. Over time, progressive aortic regurgitation is common and frequently results in the need for aortic valve replacement. Neonates with critical aortic valve stenosis remain a particularly high-risk group. More contemporary data suggest that acutely achieving an aortic valve gradient <35 mm Hg with mild aortic regurgitation may improve long-term valve performance and reduce the need for valve replacement. Continued study will help to further improve outcomes and reduce the need for future reinterventions.
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Balloon valvuloplasty of valvular pulmonary stenosis in a neonatal foal. J Vet Cardiol 2021; 36:48-54. [PMID: 34077876 DOI: 10.1016/j.jvc.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 11/21/2022]
Abstract
In a 1-day old filly with a loud heart murmur, transthoracic echocardiography revealed right ventricular hypertrophy associated with severe pulmonary valvular stenosis and a transvalvular pressure gradient (between right ventricle and pulmonary artery) of 125 mmHg. Computed tomographic angiography confirmed the finding, with no evidence of other relevant concurrent abnormalities. Balloon valvuloplasty was performed using a single balloon technique. The foal recovered well from anaesthesia. Following the procedure, the right ventricle-pulmonary artery transvalvular gradient decreased to 38 mmHg. At follow up examinations after 1 month, 1 year and 2 years, the filly showed normal exercise capacity and echocardiography confirmed the persistent substantial improvement in the transvalvular outflow gradient.
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Saef JM, Ghobrial J. Valvular heart disease in congenital heart disease: a narrative review. Cardiovasc Diagn Ther 2021; 11:818-839. [PMID: 34295708 DOI: 10.21037/cdt-19-693-b] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/29/2021] [Indexed: 12/29/2022]
Abstract
Patients with congenital heart disease (CHD) are one of the fastest growing populations in cardiology, and valvular pathology is at the center of many congenital lesions. Derangements in valvular embryology lead to several anomalies prone to dysfunction, each with hemodynamic effects that require appropriate surveillance and management. Surgical innovation has provided new treatments that have improved survival in this population, though has also contributed to esotericism in patients who already have unique anatomic and physiologic considerations. Conduit and prosthesis durability are often monitored collaboratively with general and specialized congenital-focused cardiologists. As such, general cardiologists must become familiar with valvular disease with CHD for appropriate care and referral practices. In this review, we summarize the embryology of the semilunar and atrioventricular (AV) valves as a foundation for understanding the origins of valvular CHD and describe the mechanisms that account for heterogeneity in disease. We then highlight the categories of pathology from the simple (e.g., bicuspid aortic valve, isolated pulmonic stenosis) to the more complex (e.g., Ebstein's anomaly, AV valvular disease in single ventricle circulations) with details on natural history, diagnosis, and contemporary therapeutic approaches. Care for CHD patients requires collaborative effort between providers, both CHD-specialized and not, to achieve optimal patient outcomes.
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Affiliation(s)
- Joshua M Saef
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joanna Ghobrial
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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El Tahlawi M, Morsy M, Elawady M, Abdelaziz M, Eldamanhory A. Is there any relationship between biomarkers and echocardiographic markers in patients with pulmonary stenosis underwent balloon valvuloplasty? Echocardiography 2021; 38:924-931. [PMID: 33998046 DOI: 10.1111/echo.15077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/09/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Congenital pulmonary stenosis (PS) is a progressive disease. Balloon pulmonary valvuloplasty (BPV) is the treatment of choice in valvular PS. AIM We aim to study the relationship between biomarkers and echocardiographic markers in valvular PS and to assess the impact of BPV on these markers. PATIENTS AND METHODS Patients with moderate and severe valvular PS amenable for BPV were recruited. Serum troponin I was measured. Echocardiographic assessment of PS and right ventricular (RV) function was done. All patients underwent BPV. Troponin level and echocardiographic data were re-assessed 2 weeks and 6 months after BPV. RESULTS Fifty patients with valvular PS were recruited. There was significant correlation between peak SPG and troponin (P < .001). Troponin was significantly decreased 2 weeks after BPV. Similarly, there was an initial improvement in RV function. After 6 months of follow-up, we divided patients into two groups: Group A: 36 patients with no restenosis. Group B: 14 patients with restenosis. There were high significant differences between both groups regarding troponin level and RV functions with re-elevated troponin in Group B that correlated with peak PG (r = .9, P < .001). RV function parameters in Group B became significantly worse 6 months after BPV than those after the initial 2 weeks. CONCLUSION Troponin correlates with the severity of PS and associates with RV dysfunction. Both troponin and RV functions improved with BPV. Recurrent elevation of troponin and impairment of RV function is associated with PV restenosis and could be set as an indication for repeated balloon dilatation of PV.
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Affiliation(s)
| | - Mohammad Morsy
- Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Ishii S, Fujiwara T, Ando J, Takeda N, Inaba T, Inuzuka R, Komuro I. Balloon Valvuloplasty to Treat Adult Symptomatic Pulmonary Valve Stenosis with Sequential Follow-Up Using Cardiac Magnetic Resonance Imaging in Combination with Echocardiography. Int Heart J 2020; 61:1075-1078. [PMID: 32921664 DOI: 10.1536/ihj.20-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pulmonary valve stenosis (PVS) accounts for approximately 10% of all congenital heart defects. Echocardiography and right heart catheterization are the gold standards for diagnosis of PVS and for assessing disease severity and responsiveness to treatment.Recently, cardiac magnetic resonance imaging (cMRI) has been established as an important tool to comprehensively evaluate cardiac structure and function; however, research into the usefulness of cMRI for PVS management is limited. Here, we describe a case of a 59-year-old female with isolated, severe PVS who was successfully treated with balloon pulmonary valvuloplasty (BPV) followed by sequential cMRI at 1 and 12 months. Exertional dyspnea and elevated plasma BNP concentration were observed 1 month after BPV; however, echocardiographic findings did not indicate recurrent stenosis or increased pulmonary valve regurgitation but an increase in mitral E/e'. cMRI demonstrated improved systolic forward flow and RV function with enlargement of LV volume, and the rapid increase in LV preload might be associated with the transient deterioration in symptoms and BNP level, which both gradually improved within 3 months after BPV. cMRI further depicted that a reduced RV mass index and increased RV cardiac output were achieved gradually during the follow-up period.In conclusion, cMRI in combination with echocardiography was sufficiently informative to follow-up this PVS patient both before and after BPV. cMRI is easily reproducible in adult patients; therefore, cMRI should be recommended for long-term follow-up in adult PVS patients.
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Affiliation(s)
- Satoshi Ishii
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Takayuki Fujiwara
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Jiro Ando
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo Hospital
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
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Li VWY, Wong JYL, Wang C, Chow PC, Cheung YF. Tricuspid Regurgitation in Adults after Repair of Right Ventricular Outflow Obstructive Lesions. Pediatr Cardiol 2020; 41:1153-1159. [PMID: 32394061 DOI: 10.1007/s00246-020-02366-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
We determined the prevalence and factors associated with tricuspid regurgitation (TR) in adults with repair of right ventricular (RV) outflow obstruction. A total of 256 patients (128 males) were studied at 25.7 ± 7.2 years after surgery, of whom 179 had repaired tetralogy of Fallot (TOF), 31 had pulmonary atresia with intact ventricular septum (PAIVS), and 46 had pulmonary stenosis (PS). The mitral and tricuspid annulus diameters, maximum right atrial (RA) area, RV end-systolic and end-diastolic areas, and tricuspid and pulmonary regurgitation were assessed using echocardiography. The prevalence of moderate-to-severe TR was 20.7%. Subgroup analysis revealed that prevalence was greater in patients with repaired TOF (20.7%) and PAIVS (35.5%) than PS patients (10.9%). As a group, severity of TR was found to be correlated with RA area (r = 0.35, p < 0.001), RV end-diastolic (r = 0.28, p < 0.001) and end-systolic (r = 0.22, p = 0.001) areas, and tricuspid valve annulus diameter (r = 0.15, p = 0.022). Moderate-to-severe TR was associated with development of cardiac arrhythmias with an odds ratio of 2.9 (95% CI 1.1 to 8.1, p = 0.031). Multivariate analysis revealed maximum RA area (β = 0.36, p = 0.016) as an independent determinant of severity of TR. Moderate-to-severe TR occurs in about one-fifth of adults with repaired TOF, PAVIS, and PS and is associated with RA dilation and risk of development of cardiac arrhythmias.
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Affiliation(s)
- Vivian Wing-Yi Li
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Jasmine Yan-Lam Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pak-Cheong Chow
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Yiu-Fai Cheung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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Wang SY, OuYang RZ, Hu LW, Xie WH, Peng YF, Wang L, Gao FB, Zhong YM. Right and left ventricular interactions, strain, and remodeling in repaired pulmonary stenosis patients with preserved right ventricular ejection fraction: A cardiac magnetic resonance study. J Magn Reson Imaging 2020; 52:129-138. [PMID: 31975534 DOI: 10.1002/jmri.27034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Right ventricular dilation and dysfunction is a common long-term complication in patients with repaired pulmonary stenosis (rPS). Additionally, abnormal right and left ventricular interactions have been reported in right-sided heart defect after intervention, including in pulmonary stenosis. PURPOSE To analyze ventricular strain, remodeling, and left and right ventricular interactions in rPS patients with preserved right ventricular ejection fraction (RVEF) compared with healthy children using cardiac magnetic resonance. STUDY TYPE A cross-sectional study. POPULATION In all, 34 rPS patients and 10 healthy children volunteers (controls). FIELD STRENGTH/SEQUENCE 3.0T/2D balanced steady-state free precession (2D b-SSFP) cine, late gadolinium enhancement (LGE), and 2D phase contrast (2D-PC). ASSESSMENT Pulmonary regurgitation (PR) fractions of the main pulmonary artery, biventricular volumes, masses, function, and cardiac strain. STATISTICAL TESTS Mann-Whitney U-test, t-test, Pearson correlation coefficients, Spearman's correlation coefficients, and intraclass correlation coefficients analysis were performed. RESULTS For group analysis, the right ventricular (RV) global circumferential strain and radial strain were significantly increased in patients when compared with controls (-13.57 ± 2.69 vs. -5.91 ± 3.16, P < 0.001; 25.31 ± 8.12 vs. 9.87 ± 5.32, P < 0.001, respectively). The fraction of PR displayed moderate correlation with right ventricular end-diastolic volume index (RVEDVi) (r = 0.452, P = 0.022). RVEDVi and mass index were larger in patients vs. control (104.92 ± 27.46 vs. 85.15 ± 11.98, P = 0.016; 18.28 ± 4.95g/m2 vs. 11.67 ± 2.14 g/m2 , P < 0.001, respectively). Patients presented with preserved left ventricular ejection function, but was lower than healthy controls (60.89% ± 4.89% vs. 65.95% ± 4.56%, P = 0.006). Regional circumferential strain of segment 3 of left ventricle (LV) were significantly decreased in patients (-7.79 ± 6.52 vs. -13.56 ± 3.22, P = 0.003). DATA CONCLUSION Compensated increased RV strain, myocardial remodeling of RV, and adverse right and left ventricular interactions occur in rPS patients with preserved RVEF. The decreased interventricular septum strain may lead to impaired LV function due to RV dilation as a result of PR. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;52:129-138.
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Affiliation(s)
- Shi-Yu Wang
- Department of Radiology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Rong-Zhen OuYang
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Li-Wei Hu
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wei-Hui Xie
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ya-Feng Peng
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lei Wang
- Department of Radiology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Fa-Bao Gao
- Department of Radiology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yu-Min Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Larios G, Yim D, Dragulescu A, Mertens L, Grosse-Wortmann L, Friedberg MK. Right ventricular function in patients with pulmonary regurgitation with versus without tetralogy of Fallot. Am Heart J 2019; 213:8-17. [PMID: 31071505 DOI: 10.1016/j.ahj.2019.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Right ventricular (RV) dilation from pulmonary valve regurgitation (PR) is common after intervention(s) for pulmonary stenosis (PS) or atresia and intact ventricular septum (PA/IVS). It is not well established whether PR and RV dilation have similar effects on RV function and exercise capacity in these patients compared to patients after repair of tetralogy of Fallot (rToF). The aims of this study were to compare exercise tolerance, RV function and myocardial mechanics in non-ToF versus rToF children with significantly increased and comparable RV volumes. METHODS Thirty PS or PA/IVS children after intervention(s) with significant PR and RV dilation (non-ToF group) were retrospectively matched for RV end-diastolic volume index (RVEDVi) and age with 30 rToF patients. Clinical characteristics, RV function by echocardiography and CMR, ECG and exercise capacity were compared between groups. RESULTS The groups were well matched for RVEDVi and age. Global RV function (RVEF: 48.7 ± 6.4% vs. 48.5 ± 7.2%, P = .81) and exercise capacity (% predicted peak VO2:82.5 ± 17.7% vs. 75.6 ± 20.4%, P = .27) were similarly reduced between groups. RVEDVi correlated inversely with RVEF in both groups (non-ToF:r = -0.39, P = .04, rToF:r = -0.40, P = .03). QRS duration was wider in rToF patients, and in both groups inversely correlated with RVEF (non-ToF:r = -0.77, P < .001, rToF:r = -0.69, P < .001). In contrast to global function, longitudinal RV strain was lower in rTOF vs non-TOF (-20.1 ± 3.9 vs.-25.7 ± 4.4, P < .001). CONCLUSIONS Global RV function and exercise capacity are similarly reduced in non-ToF and rToF patients with severely dilated RV, after matching by RVEDVi, suggesting a comparable impact of RV dilation on RV global function. The significance of reduced RV longitudinal function and worse dyssynchrony in rToF patients require further exploration.
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Affiliation(s)
- Guillermo Larios
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Division of Pediatrics, P. Universidad Catolica de Chile, Santiago, Chile
| | - Deane Yim
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Division of Pediatric Cardiology, Perth Children´s Hospital, Perth, Australia
| | - Andreea Dragulescu
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mark K Friedberg
- Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
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Variations in Practice Patterns and Consistency With Published Guidelines for Balloon Aortic and Pulmonary Valvuloplasty: An Analysis of Data From the IMPACT Registry. JACC Cardiovasc Interv 2019; 11:529-538. [PMID: 29566797 DOI: 10.1016/j.jcin.2018.01.253] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/18/2017] [Accepted: 01/16/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The authors sought to study variation in the practice of balloon aortic (BAV) and pulmonary valvuloplasty (BPV). BACKGROUND The IMPACT (IMProving Adult and Congenital Treatment) registry provides an opportunity to study practice variation in transcatheter interventions for congenital heart disease. METHODS The authors studied BAV and BPV in the IMPACT registry from January 1, 2011, to September 30, 2015, using hierarchical multivariable models to measure hospital-level variation in: 1) the distribution of indications for intervention; and 2) in cases with "high resting gradient" as the indication, consistency with published guidelines. RESULTS A total of 1,071 BAV cases at 60 hospitals and 2,207 BPV cases at 75 hospitals were included. The indication for BAV was high resting gradient in 82%, abnormal stress test or electrocardiogram (2%), left ventricular dysfunction (11%), and symptoms (5%). Indications for BPV were high resting gradient in 82%, right-left shunt (6%), right ventricular dysfunction (7%), and symptoms (5%). No association between hospital characteristics and distribution of indications was demonstrated. Among interventions performed for "high resting gradient," there was significant adjusted hospital-level variation in the rates of cases performed consistently with guidelines. For BAV, significant differences were seen across census regions, with hospitals in the East and South more likely to practice consistently than those in the Midwest and West (p = 0.005). For BPV, no association was found between hospital factors and rates of consistent practice, but there was significant interhospital variation (median rate ratio: 1.4; 95% confidence interval: 1.2 to 1.6; p < 0.001). CONCLUSIONS There is measurable hospital-level variation in the practice of BAV and BPV. Further research is necessary to determine whether this affects outcomes or resource use.
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Fifty-Five Years Follow-Up of 111 Adult Survivors After Biventricular Repair of PAIVS and PS. Pediatr Cardiol 2019; 40:374-383. [PMID: 30539241 DOI: 10.1007/s00246-018-2041-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
There is paucity of long-term data on adult survivors after biventricular repair of pulmonary atresia with intact ventricular septum (PAIVS) and pulmonary stenosis (PS). This study aimed to determine the cardiac and non-cardiac outcomes of adult survivors after biventricular repair of PAIVS and PS. The cardiac, neurodevelopmental and liver problems of 111 adults, 40 with PAIVS and 71 with PS, were reviewed. The median follow-up duration of our patients was 26.5 years (range 14.8-55 years). The freedom from reintervention at 30 years was 17.4% and 73.3% for PAIVS and PS patients (p < 0.001), respectively. Compared with PS patients, PAIVS patients had significantly greater prevalence of right atrial and right ventricular (RV) dilatation, and moderate to severe tricuspid and pulmonary regurgitation (all p < 0.05), and cardiac arrhythmias (22.5% vs. 8.5%, p = 0.047). The freedom from development of cardiac arrhythmias at 30 years of 68.4% and 91.6%, respectively, in PAIVS and PS patients (p = 0.03). Cox proportional hazards model identified PAIVS as an independent risk factor for reintervention (HR 4.0, 95% CI 2.1-7.6, p < 0.001) and development of arrhythmias (HR 4.1, 95% CI 1.1-14.4, p = 0.03). Neurodevelopmental problems were found in 17.5% of PAIVS patients and 7.0% of PS patients (p = 0.11). Liver problems occurred in 2 (5%) PAIVS patients, both of whom required conversion to 1.5 ventricular repair. In conclusion, long-term problems, including the need for reinterventions, cardiac arrhythmias, RV dilation, pulmonary regurgitation, and neurodevelopmental and liver issues are more prevalent in adult PAIVS than PS survivors.
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Technical factors are associated with complications and repeat intervention in neonates undergoing transcatheter right ventricular decompression for pulmonary atresia and intact ventricular septum: results from the congenital catheterisation research collaborative. Cardiol Young 2018; 28:1042-1049. [PMID: 29909817 DOI: 10.1017/s1047951118000756] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transcatheter right ventricle decompression in neonates with pulmonary atresia and intact ventricular septum is technically challenging, with risk of cardiac perforation and death. Further, despite successful right ventricle decompression, re-intervention on the pulmonary valve is common. The association between technical factors during right ventricle decompression and the risks of complications and re-intervention are not well described. METHODS This is a multicentre retrospective study among the participating centres of the Congenital Catheterization Research Collaborative. Between 2005 and 2015, all neonates with pulmonary atresia and intact ventricular septum and attempted transcatheter right ventricle decompression were included. Technical factors evaluated included the use and characteristics of radiofrequency energy, maximal balloon-to-pulmonary valve annulus ratio, infundibular diameter, and right ventricle systolic pressure pre- and post-valvuloplasty (BPV). The primary end point was cardiac perforation or death; the secondary end point was re-intervention. RESULTS A total of 99 neonates underwent transcatheter right ventricle decompression at a median of 3 days (IQR 2-5) of age, including 63 patients by radiofrequency and 32 by wire perforation of the pulmonary valve. There were 32 complications including 10 (10.5%) cardiac perforations, of which two resulted in death. Cardiac perforation was associated with the use of radiofrequency (p=0.047), longer radiofrequency duration (3.5 versus 2.0 seconds, p=0.02), and higher maximal radiofrequency energy (7.5 versus 5.0 J, p<0.01) but not with patient weight (p=0.09), pulmonary valve diameter (p=0.23), or infundibular diameter (p=0.57). Re-intervention was performed in 36 patients and was associated with higher post-intervention right ventricle pressure (median 60 versus 50 mmHg, p=0.041) and residual valve gradient (median 15 versus 10 mmHg, p=0.046), but not with balloon-to-pulmonary valve annulus ratio, atmospheric pressure used during BPV, or the presence of a residual balloon waist during BPV. Re-intervention was not associated with any right ventricle anatomic characteristics, including pulmonary valve diameter. CONCLUSION Technical factors surrounding transcatheter right ventricle decompression in pulmonary atresia and intact ventricular septum influence the risk of procedural complications but not the risk of future re-intervention. Cardiac perforation is associated with the use of radiofrequency energy, as well as radiofrequency application characteristics. Re-intervention after right ventricle decompression for pulmonary atresia and intact ventricular septum is common and relates to haemodynamic measures surrounding initial BPV.
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To AHM, Li VWY, Ng MY, Cheung YF. Quantification of Pulmonary Regurgitation by Vector Flow Mapping in Congenital Heart Patients after Repair of Right Ventricular Outflow Obstruction: A Preliminary Study. J Am Soc Echocardiogr 2017; 30:984-991. [DOI: 10.1016/j.echo.2017.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Indexed: 10/19/2022]
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18
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Abstract
PURPOSE OF REVIEW Our review is intended to provide readers with an overview of disease processes involving the pulmonic valve, highlighting recent outcome studies and guideline-based recommendations; with focus on the two most common interventions for treating pulmonic valve disease, balloon pulmonary valvuloplasty and pulmonic valve replacement. RECENT FINDINGS The main long-term sequelae of balloon pulmonary valvuloplasty, the gold standard treatment for pulmonic stenosis, remain pulmonic regurgitation and valvular restenosis. The balloon:annulus ratio is a major contributor to both, with high ratios resulting in greater degrees of regurgitation, and small ratios increasing risk for restenosis. Recent studies suggest that a ratio of approximately 1.2 may provide the most optimal results. Pulmonic valve replacement is currently the procedure of choice for patients with severe pulmonic regurgitation and hemodynamic sequelae or symptoms, yet it remains uncertain how it impacts long-term survival. Transcatheter pulmonic valve replacement is a rapidly evolving field and recent outcome studies suggest short and mid-term results at least equivalent to surgery. The Melody valve® was FDA approved for failing pulmonary surgical conduits in 2010 and for failing bioprosthetic surgical pulmonic valves in 2017 and has been extensively studied, whereas the Sapien XT valve®, offering larger diameters, was approved for failing pulmonary conduits in 2016 and has been less extensively studied. Patients with pulmonic valve disease deserve lifelong surveillance for complications. Transcatheter pulmonic valve replacement is a novel and attractive therapeutic option, but is currently only FDA approved for patients with failing pulmonary conduits or dysfunctional surgical bioprosthetic valves. New advances will undoubtedly increase the utilization of this rapidly expanding technology.
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19
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Effect of balloon annulus ratio on the outcome post balloon pulmonary valvuloplasty in children. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Kenny DP, Hijazi ZM. Current Status and Future Potential of Transcatheter Interventions in Congenital Heart Disease. Circ Res 2017; 120:1015-1026. [DOI: 10.1161/circresaha.116.309185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
Percutaneous therapies for congenital heart disease have evolved rapidly in the past 3 decades. This has occurred despite limited investment from industry and support from regulatory bodies resulting in a lack of specific device development. Indeed, many devices remain off-label with a best-fit approach often required, spurning an innovative culture within the subspecialty, which had arguably laid the foundation for many of the current and evolving structural heart interventions. Challenges remain, not least encouraging device design focused on smaller infants and the inevitable consequences of somatic growth. Data collection tools are emerging but remain behind adult cardiology and cardiac surgery and leading to partial blindness as to the longer-term consequences of our interventions. Tail coating on the back of developments in other fields of adult intervention will soon fail to meet the expanding needs for more precise interventions and biological materials. Increasing collaboration with surgical colleagues will require development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure that children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia, and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien P. Kenny
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
| | - Ziyad M. Hijazi
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
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Devanagondi R, Peck D, Sagi J, Donohue J, Yu S, Pasquali SK, Armstrong AK. Long-Term Outcomes of Balloon Valvuloplasty for Isolated Pulmonary Valve Stenosis. Pediatr Cardiol 2017; 38:247-254. [PMID: 27826708 DOI: 10.1007/s00246-016-1506-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
To evaluate the long-term cumulative incidence of ≥ moderate pulmonary regurgitation (PR) and re-intervention following balloon pulmonary valvuloplasty (BPV). While BPV for pulmonary valve stenosis (PS) relieves obstruction acutely, long-term outcomes are not well documented. Between 1982 and 2002, 211 patients had BPV for isolated PS. Follow-up data were available for 103 patients. Cumulative incidence of ≥ moderate PR and re-intervention was evaluated and risk factors for ≥ moderate PR assessed in univariate and multivariable analyses. Median age at BPV was 0.7 years (range 1 day-42.2 years); peak catheter gradient was 65 mmHg (range 31-169 mmHg); 23% had critical PS. Sixty-two patients had a recent echocardiogram with median follow-up 15.1 years (range 10.1-26.3 years); 60% had ≥ moderate PR. Three patients had pulmonary valve replacement following BPV due to symptomatic severe PR. In univariate analysis, critical PS, younger age, smaller BSA, and smaller pulmonary annulus at the time of BPV, as well as greater baseline PS gradient by catheterization, were associated with ≥ moderate PR (all p < 0.05). In multivariable analysis, only BSA < 0.3 m2 was independently associated with ≥ moderate PR (adjusted odds ratio 6.4, 95% confidence interval 1.2-33.6). In the largest study to date of > 10-year outcomes following BPV, 60% of patients with available follow-up data developed ≥ moderate PR. Few patients had pulmonary valve replacement. Patients with lower BSA at the time of BPV were more likely to have greater PR at late follow-up.
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Affiliation(s)
- Rajiv Devanagondi
- Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Box 631, Rochester, NY, 14642, USA.
| | - Dan Peck
- Department of Pediatrics, Mattell Children's Hospital, UCLA, Los Angeles, CA, USA
| | - Janaki Sagi
- Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Janet Donohue
- Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Sunkyung Yu
- Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Sara K Pasquali
- Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Aimee K Armstrong
- Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
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Valvuloplastia pulmonar en menores de 21 años. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Chaszczewski K, Kenny D, Hijazi ZM. Pulmonary Artery and Valve Catheter-Based Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Right Ventricular Outflow Tract Obstruction: Pulmonary Atresia With Intact Ventricular Septum, Pulmonary Stenosis, and Ebstein's Malformation. Pediatr Crit Care Med 2016; 17:S323-9. [PMID: 27490618 DOI: 10.1097/pcc.0000000000000818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this review are to discuss the anatomy, pathophysiology, clinical course, and current treatment strategies for pulmonary atresia with intact ventricular septum, pulmonary stenosis, and Ebstein's anomaly. DATA SOURCE MEDLINE and PubMed. CONCLUSIONS Considerable advances have been made in management strategies for these complex congenital heart lesions, which have led to improved outcomes.
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Abstract
BACKGROUND Surgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention. The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000. RESULTS The total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage. CONCLUSION Surgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.
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Figulla HR, Webb JG, Lauten A, Feldman T. The transcatheter valve technology pipeline for treatment of adult valvular heart disease. Eur Heart J 2016; 37:2226-39. [PMID: 27161617 DOI: 10.1093/eurheartj/ehw153] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 03/17/2016] [Indexed: 12/17/2022] Open
Abstract
The transcatheter valve technology pipeline has started as simple balloon valvuloplasty for the treatment of stenotic heart valves and evolved since the year 2000 to either repair or replace heart valves percutaneously with multiple devices. In this review, the present technology and its application are illuminated and a glimpse into the near future is dared from a physician's perspective.
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Affiliation(s)
- Hans R Figulla
- Universitätsklinikum Jena, Friedrich Schiller Universität Jena, Jena, Germany
| | - John G Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Lauten
- Charité-Universitaetsmedizin Berlin, Department of Cardiology Berlin, Campus Benjamin Franklin, Germany
| | - Ted Feldman
- Cardiology Division, NorthShore University HealthSystem Evanston, Evanston, USA
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To AHM, Lai CTM, Wong SJ, Cheung YF. Right Atrial Mechanics Long-Term after Biventricular Repair of Pulmonary Atresia or Stenosis with Intact Ventricular Septum. Echocardiography 2015; 33:586-95. [DOI: 10.1111/echo.13121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ashley Hoi-man To
- Division of Pediatric Cardiology; Department of Pediatrics and Adolescent Medicine; The University of Hong Kong; Hong Kong China
| | - Clare Tik-man Lai
- Division of Pediatric Cardiology; Department of Pediatrics and Adolescent Medicine; The University of Hong Kong; Hong Kong China
| | - Sophia J. Wong
- Division of Pediatric Cardiology; Department of Pediatrics and Adolescent Medicine; The University of Hong Kong; Hong Kong China
| | - Yiu-fai Cheung
- Division of Pediatric Cardiology; Department of Pediatrics and Adolescent Medicine; The University of Hong Kong; Hong Kong China
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Idrizi S, Milev I, Zafirovska P, Tosheski G, Zimbakov Z, Ampova-Sokolov V, Angjuseva T, Mitrev Z. Interventional Treatment of Pulmonary Valve Stenosis: A Single Center Experience. Open Access Maced J Med Sci 2015; 3:408-12. [PMID: 27275259 PMCID: PMC4877828 DOI: 10.3889/oamjms.2015.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 07/28/2015] [Accepted: 08/12/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Percutaneous pulmonary valvuloplasty is well established treatment of choice in pulmonary valve stenosis. AIM The aim of our study was to present our experience with the interventional technique, its immediate and mid-term effectiveness as well as its complication rate. MATERIAL AND METHODS The study included 43 patients, where 33 (74%) of them were children between the age of 1 month and 15 years. RESULTS The procedure was successful in 38 patients or 90%. Mean peak to peak transvalvular gradient was reduced from 91.2 mmHg (55-150 mmHg) to 39.1 mmHg (20-80 mmHg). Follow- up of patients was between 2 and 13 years and included echocardiographic evaluation of pulmonary valve gradient, right heart dimensions and function as well as assessment of pulmonary regurgitation. We experienced one major complication pericardial effusion in a 5 months old child that required pericardiocenthesis. Six patients (13.9%) required a second intervention. During the follow up period there was significant improvement of right heart function and echocardiography parameters. Mild pulmonary regurgitation was noted in 24 (55%) patients, and four (9%) patients developed moderate regurgitation, without affecting the function of the right ventricle. CONCLUSIONS Percutaneous pulmonary valvuloplasty is an effective procedure in treatment of pulmonary stenosis with good short and mid-term results.
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Affiliation(s)
- Shpend Idrizi
- Special Hospital for Surgical Diseases “Filip Vtori”, Skopje, Republic of Macedonia
| | - Ivan Milev
- Special Hospital for Surgical Diseases “Filip Vtori”, Skopje, Republic of Macedonia
| | - Planinka Zafirovska
- Special Hospital for Surgical Diseases “Filip Vtori”, Skopje, Republic of Macedonia
| | - Goce Tosheski
- Special Hospital for Surgical Diseases “Filip Vtori”, Skopje, Republic of Macedonia
| | - Zan Zimbakov
- Special Hospital for Surgical Diseases “Filip Vtori”, Skopje, Republic of Macedonia
| | - Vilma Ampova-Sokolov
- Special Hospital for Surgical Diseases “Filip Vtori”, Skopje, Republic of Macedonia
| | - Tanja Angjuseva
- Special Hospital for Surgical Diseases “Filip Vtori”, Skopje, Republic of Macedonia
| | - Zan Mitrev
- Special Hospital for Surgical Diseases “Filip Vtori”, Skopje, Republic of Macedonia
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Ronai C, Rathod RH, Marshall AC, Oduor R, Gauvreau K, Colan SD, Brown DW. Left Ventricular Dysfunction Following Neonatal Pulmonary Valve Balloon Dilation for Pulmonary Atresia or Critical Pulmonary Stenosis. Pediatr Cardiol 2015; 36:1186-93. [PMID: 25764509 DOI: 10.1007/s00246-015-1142-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/04/2015] [Indexed: 11/24/2022]
Abstract
Pulmonary valve (PV) balloon dilation (BD) is the primary therapy for infants born with critical pulmonary stenosis (PS) or membranous pulmonary atresia with intact ventricular septum (PAIVS). We observed left ventricular (LV) dysfunction in patients following BD and sought to determine its incidence, clinical course and associated risk factors. Clinical, echocardiographic and catheterization data for all patients who underwent neonatal (<2 weeks age) PV BD for critical PS or PAIVS between January 2000 and February 2014 were retrospectively analyzed (n = 129). Post-procedure LV dysfunction was defined as ejection fraction (EF) <54 %. Median age at PV BD was 1 day. Most (71 %) patients had critical PS. Median PV diameter pre-BD was 6.0 mm with PV z-scores -4.1 to 0.9, median LV EF pre-BD was 58 %. Post-BD LV dysfunction developed in 45 patients (35 %); 15 patients had LV EF ≤40 %. Median time to normalization of LV EF was 10 days (range 2-72). In univariate analysis, diagnosis (critical PS or PAIVS), right ventricle to LV pressure ratio pre-BD, acute procedural complication and post-BD inotropic support were not associated with post-BD LV dysfunction. In multivariable analysis, the predictors of post-procedure LV dysfunction were lower PV z-score (OR 1.81, p 0.04), tricuspid regurgitation pre-BD ≥ moderate (OR 3.73, p 0.008) and larger right ventricular apical area (OR 1.99, p 0.04). LV dysfunction post-neonatal PV BD develops in a significant number of patients (35 %) and can be severe, but resolves. The risk of developing LV dysfunction post-PV BD is highest in patients with larger right ventricles.
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Affiliation(s)
- Christina Ronai
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA,
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Rommel JJ, Yadav PK, Stouffer GA. Causes and hemodynamic findings in chronic severe pulmonary regurgitation. Catheter Cardiovasc Interv 2015; 92:E197-E203. [DOI: 10.1002/ccd.26073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/23/2015] [Indexed: 11/08/2022]
Affiliation(s)
- John J. Rommel
- Division of Cardiology; University of North Carolina; Chapel Hill North Carolina
| | - Pradeep K. Yadav
- Division of Cardiology; University of North Carolina; Chapel Hill North Carolina
| | - George A. Stouffer
- Division of Cardiology; University of North Carolina; Chapel Hill North Carolina
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31
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Mercer-Rosa L, Ingall E, Zhang X, McBride M, Kawut S, Fogel M, Paridon S, Goldmuntz E. The impact of pulmonary insufficiency on the right ventricle: a comparison of isolated valvar pulmonary stenosis and tetralogy of fallot. Pediatr Cardiol 2015; 36:796-801. [PMID: 25519915 PMCID: PMC4368468 DOI: 10.1007/s00246-014-1087-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/11/2014] [Indexed: 01/28/2023]
Abstract
Pulmonary insufficiency (PI) is associated with right ventricular (RV) dilation, dysfunction, and exercise intolerance in patients with tetralogy of fallot (TOF). We sought to compare RV function and exercise performance in patients with valvar pulmonary stenosis (VPS) following pulmonary balloon valvuloplasty to those with repaired TOF with similar degrees of PI. We performed a cross-sectional study of patients with VPS and TOF. Cardiac magnetic resonance (CMR) and exercise stress test were performed. Subjects were matched by time from initial procedure and severity of PI using propensity scores. After matching, there were 16 patients with VPS and 16 with TOF for comparison, with similar demographics. Time from initial procedure was 14 years (12-16), p = 0.92, and pulmonary regurgitant fraction was 19 % (6-31), p = 0.94, Patients with TOF had lower ejection fraction [58 % (53-66) vs. 65 % (60-69), p = 0.04] and more RV hypertrophy [69 g/m(2) (52-86) vs. 44 g/m(2) (32-66), p = 0.04] compared to those with VPS. Aerobic capacity was worse in patients with TOF [68 ± 19 % mVO2 (56-84) vs. 82 ± 9.2 % (74-89) in VPS, p = 0.01], with a trend for less habitual physical activity [0.9 (0-12) vs. 8 h/week (4-12), p = 0.056], respectively. With similar degrees of PI, patients with TOF demonstrate worse RV function and aerobic capacity as compared to patients with just VPS. Habitual exercise may in part explain differences in exercise performance and should be further explored.
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Affiliation(s)
- Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,
| | - Eitan Ingall
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Xuemei Zhang
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Michael McBride
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Steven Kawut
- Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mark Fogel
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Stephen Paridon
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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32
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Interventionelle Kinderkardiologie. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3263-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
In this review, we discuss right-sided heart valve disease, namely tricuspid regurgitation (TR), tricuspid stenosis, pulmonary regurgitation, pulmonary stenosis and right-sided endocarditis. These are frequently seen in conjunction with other diseases, making assessment of their significance more difficult, but it has become increasingly clear that moderate or severe right-sided heart valve disease, in particular TR, is associated with worse prognosis. There remain large gaps in our knowledge of medical and interventional treatment, but in this article we outline what is known about the causes, presentation and management of these commonly seen conditions.
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Affiliation(s)
- S Coffey
- Cardiology Research Group, Department of Medicine, University of Otago, Dunedin, New Zealand; Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, UK
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Sunahara H, Fujii Y, Sugimoto K, Aoki T, Sugahara G, Shirota K. Restenosis after balloon valvuloplasty in a dog with pulmonary stenosis. J Vet Med Sci 2014; 77:95-9. [PMID: 25252640 PMCID: PMC4349544 DOI: 10.1292/jvms.14-0242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A two-month-old female Chihuahua was diagnosed as severe pulmonary valvular stenosis (PS). Although balloon valvuloplasty (BV) was successfully performed, restenosis was observed 19 months after the procedure. Euthanasia was chosen due to low output syndrome during the surgical repair attempted when the dog was 5 years old. Postmortem examination revealed markedly thickened pulmonary valve due to the increase of extracellular matrix which might be produced by increased α smooth muscle actin-positive myofibroblasts. The thickening of the valve was associated with restriction of the valve's motion, resulting in restenosis in the present case. This is the first case report documented histopathological and immunohistochemical findings of the restenotic pulmonary valve in dogs with PS after BV.
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Affiliation(s)
- Hiroshi Sunahara
- Laboratory of Surgery 1, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201, Japan
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Gan CH, Bhat A, Eshoo S, Denniss AR. Cardiac vignette: isolated pulmonary regurgitation. Heart Lung Circ 2014; 23:e248-50. [PMID: 25127669 DOI: 10.1016/j.hlc.2014.07.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 06/12/2014] [Accepted: 07/11/2014] [Indexed: 11/27/2022]
Abstract
Isolated pulmonary regurgitation (PR) is a rare occurrence with only a handful of documented cases worldwide. Though usually well tolerated in childhood, chronic PR can eventually lead to RV dysfunction and ventricular arrhythmias. In this cardiac vignette, we describe a case of isolated PR in a young female presenting with syncope and explore the natural history, different investigative modalities as well as issues in clinical management of this rare condition.
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Affiliation(s)
- Chieh Howe Gan
- Department of Cardiology, Blacktown Hospital, and University of Western Sydney, Sydney, NSW, Australia.
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, and University of Western Sydney, Sydney, NSW, Australia
| | - Suzanne Eshoo
- Department of Cardiology, Blacktown Hospital, and University of Western Sydney, Sydney, NSW, Australia
| | - A Robert Denniss
- Department of Cardiology, Blacktown Hospital, and University of Western Sydney, Sydney, NSW, Australia
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Giardini A, Cervi E. Asymptomatic adults with mild/moderate isolated native pulmonary valve stenosis are in need of treatment… but not the kind you are thinking of! Heart 2014; 100:1313-4. [DOI: 10.1136/heartjnl-2014-306012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Meadows JJ, Moore PM, Berman DP, Cheatham JP, Cheatham SL, Porras D, Gillespie MJ, Rome JJ, Zahn EM, McElhinney DB. Use and Performance of the Melody Transcatheter Pulmonary Valve in Native and Postsurgical, Nonconduit Right Ventricular Outflow Tracts. Circ Cardiovasc Interv 2014; 7:374-80. [DOI: 10.1161/circinterventions.114.001225] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Jeffery J. Meadows
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Phillip M. Moore
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Darren P. Berman
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - John P. Cheatham
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Sharon L. Cheatham
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Diego Porras
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Matthew J. Gillespie
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Jonathan J. Rome
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Evan M. Zahn
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
| | - Doff B. McElhinney
- From the Division of Cardiology, UCSF Benioff Children’s Hospital, University of California, San Francisco (J.J.M., P.M.M.); Division of Cardiology, Miami Children’s Hospital, FL (D.P.B.); Division of Cardiology, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus (J.P.C., S.L.C.); Department of Cardiology, Children’s Hospital Boston, MA (D.P.); Division of Cardiology, The Children’s Hospital of Philadelphia, PA (M.J.G., J.J.R.); Division of Cardiology, Cedars-Sinai
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Merino-Ingelmo R, Santos-de Soto J, Coserria-Sánchez F, Descalzo-Señoran A, Valverde-Pérez I. Resultados a largo plazo de la valvuloplastia transluminal percutánea en la estenosis valvular pulmonar en población pediátrica. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Li SJ, Yu HK, Wong SJ, Cheung YF. Right and left ventricular mechanics and interaction late after balloon valvoplasty for pulmonary stenosis. Eur Heart J Cardiovasc Imaging 2014; 15:1020-8. [PMID: 24771758 DOI: 10.1093/ehjci/jeu058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS This study sought to explore right (RV) and left ventricular (LV) mechanics and ventricular-ventricular interaction in adolescents and young adults late after percutaneous balloon pulmonary valvoplasty (PBPV) for valvar pulmonary stenosis (PS). METHODS AND RESULTS Potential late effects of PS despite PBPV on cardiac mechanics have not been well defined. Thirty-one patients aged 20.2 ± 7.6 years were studied at 18 ± 6 years after PBPV. Ventricular myocardial deformation was determined using speckle tracking echocardiography, while RV and LV volumes and ejection fraction as well as LV systolic dyssynchrony index were assessed by three-dimensional echocardiography. The results were compared with those of 30 controls. Pulmonary regurgitation, mostly trivial to mild, was present in 90% (28/31) of patients. Compared with controls, patients had significantly greater RV end-diastolic (P < 0.001), RV end-systolic (P < 0.001), and LV end-systolic (P = 0.04) volumes as well as lower LV ejection fraction (P < 0.001). For deformation, patients had significantly reduced RV longitudinal systolic strain (P = 0.004), decreased LV circumferential systolic strain (P < 0.001), and strain rate (P = 0.001) as well as greater LV mechanical dyssynchrony (P < 0.001). In patients, RV end-diastolic and end-systolic volumes correlated with LV circumferential strain (r = -0.47, P = 0.008 and r = -0.36, P = 0.049, respectively) and dyssynchrony (r = 0.53, P = 0.002 and r = 0.49, P = 0.005, respectively). Patients who had PBPV at age ≤1 year had ventricular deformation indices similar to those who had interventions beyond 1 year. CONCLUSION Impaired RV and LV mechanics and adverse ventricular-ventricular interaction occur in adolescents and young adults late after balloon valvoplasty for isolated valvar PS.
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Affiliation(s)
- Shu-Juan Li
- Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, 102, Pokfulam Road, Hong Kong, China Present address: The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Hong-Kui Yu
- Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, 102, Pokfulam Road, Hong Kong, China Present address: Shenzhen Children's Hospital, Guangdong, China
| | - Sophia J Wong
- Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, 102, Pokfulam Road, Hong Kong, China
| | - Yiu-Fai Cheung
- Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, 102, Pokfulam Road, Hong Kong, China
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40
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Geva T. Is MRI the preferred method for evaluating right ventricular size and function in patients with congenital heart disease?: MRI is the preferred method for evaluating right ventricular size and function in patients with congenital heart disease. Circ Cardiovasc Imaging 2014; 7:190-7. [PMID: 24449548 DOI: 10.1161/circimaging.113.000553] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA
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41
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Merino-Ingelmo R, Santos-de Soto J, Coserria-Sánchez F, Descalzo-Señoran A, Valverde-Pérez I. Long-term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis in the pediatric population. ACTA ACUST UNITED AC 2014; 67:374-9. [PMID: 24774730 DOI: 10.1016/j.rec.2013.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/29/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous pulmonary valvuloplasty is the preferred interventional procedure for pulmonary valve stenosis. The aim of this study was to evaluate the effectiveness of this technique, assess the factors leading to its success, and determine the long-term results in the pediatric population. METHODS The study included 53 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty between December 1985 and December 2000. Right ventricular size and functional echocardiographic parameters, such as pulmonary regurgitation and residual transvalvular gradient, were assessed during long-term follow-up. RESULTS Peak-to-peak transvalvular gradient decreased from 74 mmHg [interquartile range, 65-100 mmHg] to 20 mmHg [interquartile range, 14-34 mmHg]. The procedure was unsuccessful in 2 patients (3.77%). The immediate success rate was 73.58%. Follow-up ranged from 10 years to 24 years (median, 15 years). During follow-up, all patients developed late pulmonary regurgitation which was assessed as grade II in 58.4% and grade III in 31.2%. There was only 1 case of long-term restenosis (2.1%). Severe right ventricular dilatation was observed in 27.1% of the patients. None of the patients developed significant right ventricular dysfunction. Pulmonary valve replacement was not required in any of the patients. CONCLUSIONS Percutaneous balloon valvuloplasty is an effective technique in the treatment of pulmonary valve stenosis with good long-term results.
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Affiliation(s)
- Raquel Merino-Ingelmo
- Unidad de Cardiología y Hemodinámica Infantil, Hospital Virgen del Rocío, Seville, Spain.
| | - José Santos-de Soto
- Unidad de Cardiología y Hemodinámica Infantil, Hospital Virgen del Rocío, Seville, Spain
| | - Félix Coserria-Sánchez
- Unidad de Cardiología y Hemodinámica Infantil, Hospital Virgen del Rocío, Seville, Spain
| | | | - Israel Valverde-Pérez
- Unidad de Cardiología y Hemodinámica Infantil, Hospital Virgen del Rocío, Seville, Spain
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Mylotte D, Martucci G, Piazza N, McElhinney D. Percutaneous options for heart failure in adults with congenital heart disease. Heart Fail Clin 2013; 10:179-96. [PMID: 24275303 DOI: 10.1016/j.hfc.2013.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the context of congenital heart disease (CHD), the complex biochemical and physiologic response to the pressure- or volume-loaded ventricle can be induced by stenotic and shunt/regurgitant lesions, respectively. A range of transcatheter therapies have recently emerged to expand the therapeutic potential of the more traditional surgical and medical interventions for heart failure in patients with CHD. Together, these complementary interventions aim to treat the growing patient population with adult CHD (ACHD). In this article, the most commonly used transcatheter interventions for heart failure in patients with ACHD are reviewed.
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Affiliation(s)
- Darren Mylotte
- Department of Interventional Cardiology, McGill University Health Centre, Royal Victoria Hospital, 687, Pine Avenue West, Montréal H3A-1A1, Québec, Canada
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Catheter Intervention for Congenital Heart Disease at Risk of Circulatory Failure. Can J Cardiol 2013; 29:786-95. [DOI: 10.1016/j.cjca.2013.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 11/24/2022] Open
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Abstract
Deleterious long-term effects of pulmonary regurgitation after tetralogy of Fallot (TOF) repair have become evident during the last two decades. Subsequently, different groups have developed strategies aimed at preserving the pulmonary valve function. However, the results of these approaches are not well known. From July 2009 through March 2012, 38 patients underwent primary repair of TOF at the authors' institution. Of these, 12 children (7 boys) underwent attempted pulmonary valve-sparing surgery with intraoperative dilation of the pulmonary valve. The technical details as well as the echocardiographic preoperative and follow-up data for this repair were recorded, with a special focus on the feasibility of the technique and the effects on pulmonary valve function. No patient in the series died. At repair, the median age was 6 months (range 3.4-126 months), and the median weight was 7.6 kg (range 4.7-47 kg). Intraoperative dilation of the pulmonary valve was technically feasible for all the patients. Two patients had unsuccessful dilation and underwent a transannular patch procedure. During a median follow-up period of 22 months (range 6-30 months), the pulmonary valve diameter and z-score improved significantly. Moreover, the annular size normalized, whereas the mean right ventricular outflow tract (RVOT) gradient remained at the mild level (median, 24 mmHg; range 12-36 mmHg). At the most recent follow-up evaluation, three patients showed moderate pulmonary regurgitation. Intraoperative dilation of the pulmonary valve in patients undergoing TOF repair is feasible and provides good relief of obstruction. Moreover, the pulmonary valve annulus grows through the follow-up period. Longer follow-up studies are needed to evaluate the exact role of this strategy in this population.
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Luijnenburg SE, de Koning WB, Romeih S, van den Berg J, Vliegen HW, Mulder BJ, Helbing WA. Exercise capacity and ventricular function in patients treated for isolated pulmonary valve stenosis or tetralogy of Fallot. Int J Cardiol 2012; 158:359-63. [DOI: 10.1016/j.ijcard.2011.01.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 12/29/2010] [Accepted: 01/14/2011] [Indexed: 10/18/2022]
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Margey R, Inglessis-Azuaje I. Percutaneous Therapies in the Treatment of Valvular Pulmonary Stenosis. Interv Cardiol Clin 2012; 1:101-119. [PMID: 28582060 DOI: 10.1016/j.iccl.2011.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Transcatheter balloon pulmonary valvuloplasty (BPV) is the standard of care in managing symptomatic patients with moderate-to-severe pulmonary valvular stenosis, or asymptomatic patients with severe pulmonary valvular stenosis or with moderate pulmonary stenosis and evidence of objective exercise intolerance or right ventricular dysfunction. This article discusses the incidence, causes, and pathophysiology of valvular pulmonary stenosis in adolescents and adults; its natural history and noninvasive evaluation; the current guideline-recommended indications for BPV; the technical aspects of performing BPV; the immediate and long-term outcomes after valvuloplasty; and the complications and safety of the procedure. Also discussed is the role of this procedure in neonatal critical pulmonary stenosis and in percutaneous pulmonary valve replacement for patients with prior pulmonic valve interventions or degenerated right ventricular pulmonary artery conduits.
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Affiliation(s)
- Ronan Margey
- Structural Heart Disease and Interventional Cardiology, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Ignacio Inglessis-Azuaje
- Adult Congenital Heart Disease Intervention, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Legendre A, Boudjemline Y. Traitement percutané des valvulopathies congénitales. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2011. [DOI: 10.1016/s1878-6480(11)70348-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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DeMaria AN, Bax JJ, Ben-Yehuda O, Feld GK, Greenberg BH, Hall J, Hlatky M, Lew WY, Lima JA, Maisel AS, Narayan SM, Nissen S, Sahn DJ, Tsimikas S. Highlights of the Year in JACC 2010. J Am Coll Cardiol 2011; 57:480-514. [DOI: 10.1016/j.jacc.2010.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
The clinical detection and quantification of tricuspid valve disease, although important, is not entirely accurate. Diagnostic evaluation is based on echocardiography, and color flow Doppler is useful for quantifying tricuspid regurgitation. Echocardiography provides information on heart chamber dimensions, right ventricular function, and the degree of pulmonary hypertension. In addition, tricuspid stenosis can be accurately assessed using mean and end-diastolic pressure gradient measurements. The treatment options for tricuspid stenosis include balloon valvuloplasty and surgical valve repair. Functional tricuspid regurgitation associated with left heart disease may require surgical attention during an operation to treat the left heart disease. Severe tricuspid regurgitation usually requires surgery to be performed in association with mitral valve surgery. Mild-to-moderate tricuspid regurgitation requires surgery when annular dilatation or severe pulmonary hypertension is present. The surgical options include tricuspid valve repair, with or without an annuloplasty ring. In patients with a primary anatomic deformity of the tricuspid valve, replacement of the valve with a bioprosthesis or mechanical valve may be considered. Intermediate and long-term results favor annuloplasty valve repair over valve replacement. Pulmonary valve disease is predominantly congenital, and generally takes the form of pulmonary stenosis. Pulmonary regurgitation often results from surgical or balloon valvuloplasty and is associated with deleterious long-term sequelae. The recent development of percutaneous valve replacement was a major advance.
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Affiliation(s)
- Pravin M Shah
- Hoag Heart Valve Center, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA.
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