Effects of Transcatheter Pulmonary Valve Replacement on the Hemodynamic and聽Ventricular Response to Exercise in聽Patients With Obstructed Right Ventricle-to-Pulmonary Artery Conduits

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• 作者：Babar S. Hasan ; MD ; ^{babar.hasan@aku.edu" class="auth_mail} ; Fatima I. Lunze ; MD ; ScD ; PhD ; Ming Hui Chen ; MD ; David W. Brown ; MD ; Matthew J. Boudreau ; RDCS ; Jonathan Rhodes ; MD ; Doff B. McElhinney ; MD
• 关键词：congenital heart defects ; exercise echocardiography ; percutaneous valve replacement
• 刊名：JACC: Cardiovascular Interventions
• 出版年：May 2014
• 年：2014
• 卷：7
• 期：5
• 页码：530-542
• 全文大小：1736 K

文摘

This study sought to investigate the effects of exercise on the right ventricle in patients with an obstructed right ventricular outflow tract (RVOT) conduit before and after transcatheter pulmonary valve replacement (TPVR).

bsSec_2">Background

bspara0015">Conventionally, assessment of the right ventricle in congenital heart disease patients with dysfunctional RVOT conduits is performed at rest. However, this does not reflect dynamic exercise changes.

bsSec_3">Methods

bspara0020">Exercise stress echocardiography (ESE) before and 6 months after TPVR was performed. ESE protocol included measurement of rest and immediate post-exercise RVOT maximal instantaneous gradients (MIGs), right ventricular (RV) systolic pressure, 2-dimensional fractional area change, and global longitudinal strain (GLS).

bsSec_4">Results

bspara0025">Twenty patients with RVOT conduit obstruction (median age, 18 years), the majority (n = 14) with tetralogy of Fallot, completed the study. Pre-TPVR, the median resting MIG across the RVOT was 53 mm Hg (23 to 95 mm Hg) and increased to 93 mm Hg (49 to 156 mm Hg; p < 0.001) with exercise. After TPVR, the median MIG at rest was 26 mm Hg (6 to 41 mm Hg, and after exercise, it was 45 mm Hg (9 to 102 mm Hg), both significantly lower than before TPVR (p ≤ 0.001), but there was still a substantial increase in gradient with exercise in many patients. The RV fractional area change, RV GLS, and left ventricular GLS, both at rest and after exercise, were significantly greater after TPVR than before. A greater pre-TPVR exercise-related increase in RV function was associated with improvement in peak Vob>2b> after TPVR (p = 0.01).

bsSec_5">Conclusions

bspara0030">In patients with obstructed RVOT conduits, TPVR resulted in significant improvement in conduit stenosis and RV function at both rest and at peak exercise and in exercise cardiopulmonary function. The ability to augment RV function at peak exercise before TPVR was associated with improved exercise capacity 6 months after TPVR.