1. Branch Pulmonary Artery Valve Implantation Reduces Pulmonary Regurgitation and Improves Right Ventricular Size/Function in Patients With Large Right Ventricular Outflow Tracts.
- Author
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Qureshi AM, Bansal N, McElhinney DB, Boudjemline Y, Forbes TJ, Maschietto N, Shahanavaz S, Cheatham JP, Krasuski R, Lamers L, Chessa M, Morray BH, Goldstein BH, Noel CV, Wang Y, and Gillespie MJ
- Subjects
- Adolescent, Adult, Angiography, Cardiac Catheterization adverse effects, Cardiac Catheterization instrumentation, Child, Europe, Feasibility Studies, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation instrumentation, Humans, Hypertrophy, Right Ventricular diagnostic imaging, Magnetic Resonance Imaging, Male, Middle Aged, Pulmonary Valve diagnostic imaging, Pulmonary Valve physiopathology, Pulmonary Valve Insufficiency diagnostic imaging, Pulmonary Valve Insufficiency physiopathology, Recovery of Function, Retrospective Studies, Time Factors, Treatment Outcome, United States, Ventricular Dysfunction, Right diagnostic imaging, Young Adult, Cardiac Catheterization methods, Heart Valve Prosthesis Implantation methods, Hypertrophy, Right Ventricular physiopathology, Pulmonary Valve surgery, Pulmonary Valve Insufficiency surgery, Ventricular Dysfunction, Right physiopathology, Ventricular Function, Right, Ventricular Remodeling
- Abstract
Objectives: The authors sought to assess the intermediate-term effects of percutaneous placed valves in the branch pulmonary artery (PA) position., Background: Most patients with large right ventricular outflow tracts (RVOTs) are excluded from available percutaneous pulmonary valve options. In some of these patients, percutaneous branch PA valve implantation may be feasible. The longer-term effects of valves in the branch PA position is unknown., Methods: Retrospective data were collected on patients with significant pulmonary regurgitation who had a percutaneous branch PA valve attempted., Results: Percutaneous branch PA valve implantation was attempted in 34 patients (18 bilateral and 16 unilateral). One-half of the patients were in New York Heart Association (NHYA) functional class III or IV pre-implantation. There were 2 failed attempts and 6 procedural complications. At follow-up, only 1 patient had more than mild valvar regurgitation. The right ventricular end-diastolic volume index decreased from 147 (range: 103 to 478) ml/m
2 to 101 (range: 76 to 429) ml/m2 , p < 0.01 (n = 16), and the right ventricular end-systolic volume index decreased from 88.5 (range: 41 to 387) ml/m2 to 55.5 (range: 40.2 to 347) ml/m2 , p < 0.01 (n = 13). There were 5 late deaths. At a median follow-up of 2 years, all other patients were in NYHA functional class I or II., Conclusions: Percutaneous branch PA valve implantation results in a reduction in right ventricular volume with clinical benefit in the intermediate term. Until percutaneous valve technology for large RVOTs is refined and more widely available, branch PA valve implantation remains an option for select patients., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2018
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