Biventricular Heart Remodeling After Percutaneous or Surgical Pulmonary Valve Implantation: Evaluation by Cardiac Magnetic Resonance

The predictive role of right ventricular late gadolinium enhancement in patients with tetralogy of Fallot undergoing pulmonary valve replacement

BACKGROUND

Our purpose was to evaluate the correlations between right ventricular (RV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) in patients with tetralogy of Fallot (ToF) scheduled for pulmonary valve replacement (PVR) and post-PVR functional data.

METHODS

We retrospectively reviewed ToF patients scheduled for PVR who underwent two CMR examinations at our institution, one before the procedure (CMR-0), including contrast-enhanced sequences, and one after the procedure (CMR-1). Functional left and RV data were obtained by segmenting short-axis stacks on both CMR examinations, and normalised variations were calculated by dividing differences between CMR-1 and CMR-0 by the intercurring time interval, whereas the RV scar burden was assessed on CMR-0 LGE sequences both semiquantitatively and quantitatively. Data were reported as median and interquartile range, differences were appraised with the Mann-Whitney U test, while correlations were assessed with Spearman's ρ.

RESULTS

Fifteen patients with a median age of 25 years (16-29), including 9 (60%) males, with a median time interval between CMR-0 and CMR-1 of 17 months (12-23), were retrospectively reviewed. The semiquantitative LGE score at CMR-0 was 7 (6-9), and LGE volume was 4.49 mL (3.70-5.78), covering 5.63% (4.92-7.00) of the RV. RV LGE score showed a moderate positive correlation with the normalised variation of RV stroke volume (ρ = 0.662, p = 0.007) and a borderline moderate positive correlation with the normalised variation of RV end-diastolic indexed volume (ρ = 0.513, p = 0.050).

CONCLUSIONS

The assessment of RV LGE before PVR may provide insights on post-PVR functional data, potentially facilitating a patient-tailored treatment pathway.

Transcatheter Versus Surgical Pulmonary Valve Replacement: A Systemic Review and Meta-Analysis

BACKGROUND

Transcatheter pulmonary valve replacement (TPVR) has emerged as an alternative to surgery in patients with pulmonary valve dysfunction.

METHODS

We searched the Medline and Cochrane databases since their inception to January 2019 as well as references from article, for all publications comparing TPVR with surgical PVR (SPVR). Studies were considered for inclusion if they reported comparative data regarding any of the study endpoints. The primary endpoint was early mortality after PVR. Secondary endpoints included procedure-related complications, length of hospital stay, mortality during follow-up, infective endocarditis, need for reintervention, post-PVR transpulmonary peak systolic gradient, and significant pulmonary regurgitation.

RESULTS

There were no differences in perioperative mortality between groups (0.2% vs 1.2%; pooled odds ratio, 0.56; 95% confidence interval, 0.19-1.59; P = .27, I² = 0%). However TPVR conferred a significant reduction in procedure-related complications and length of hospital stay compared with SPVR. Midterm mortality and the need for repeat intervention were similar with both techniques, but pooled infective endocarditis was significantly more frequent in the TPVR group (5.8 vs 2.7%; pooled odds ratio, 3.09; 95% confidence interval, 1.89-5.06; P < .001, I² = 0%). TPVR was associated with less significant PR and a trend towards a lower transpulmonary systolic gradient during follow-up.

CONCLUSIONS

TPVR is a safe alternative to SPVR in selected patients and is associated with a shorter length of hospital stay and fewer procedure-related complications. At midterm follow-up TPVR was comparable with SPVR in terms of mortality and repeat intervention but was associated with an increased risk of infective endocarditis.

Repaired Congenital Heart Disease in Older Children and Adults: Up-to-Date Practical Assessment and Characteristic Imaging Findings

Because of a recent increase in survival rates and life expectancy of patients with congenital heart disease (CHD), radiologists are facing new challenges when imaging the peculiar anatomy of individuals with repaired CHD. Cardiac computed tomography and magnetic resonance are paramount noninvasive imaging tools that are useful in assessing patients with repaired CHD, and both techniques are increasingly performed in centers where CHD is not the main specialization. This review provides general radiologists with insight into the main issues of imaging patients with repaired CHD, and the most common findings and complications of each individual pathology and its repair.

Percutaneous pulmonary valve implantation in grown-up congenital heart disease patients: Insights from the Zurich experience

OBJECTIVES

The aim of the study was to assess indications, procedural success, complications, echocardiographic, and clinical outcomes of percutaneous pulmonary valve implantation (PPVI) in adult patients with congenital heart disease (CHD).

BACKGROUND

PPVI offers a non-surgical treatment option for failing prosthetic conduits in pulmonary position. However, efficacy and clinical outcomes after PPVI are still underreported.

METHODS

From January 2008 to March 2016, 25 adult CHD patients with right ventricular outflow tract (RVOT) stenosis and/or pulmonary regurgitation underwent PPVI in our institution. Clinical and echocardiographic data was collected at baseline, at 12 months of follow-up and yearly afterwards.

RESULTS

Tetralogy of Fallot and repaired pulmonary atresia were among the most prevalent underlying congenital defects. Twenty-one (84%) received a Medtronic Melody® and four (16%) patients an Edwards Sapien valve prosthesis. The PPVI procedure was successful in all 25 patients. Pre-stenting was performed in all but two (8%) patients. PPVI reduced peak-to-peak pulmonary valve gradient from 43 (IQR 28-60) mmHg to 16 (IQR 14-22) mmHg (P < 0.001). Periprocedural complications occurred in two (8%) patients (tricuspid valve damage, pulmonary artery perforation). Over a median follow-up of 43 (IQR 18-58) months all patients were alive. Only two (8%) required re-operation and two (8%) developed stent fractures (one of them had not undergone pre-stenting). NYHA functional class improved significantly, with 20 (80%) patients in NYHA class I on follow-up.

CONCLUSIONS

PPVI with Medtronic Melody or Edwards Sapien valve conduits is safe and provides effective relief from right ventricular outflow tract obstruction or pulmonary regurgitation.