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Acute and short-term haemodynamic impact of transcatheter pulmonary valve implantation on left ventricular systolic and diastolic function

Part of: Echocardiography Tetralogy of Fallot (TOF) Interventional Cardiology

Published online by Cambridge University Press:  16 March 2021

Ryan A. Romans Open the ORCID record for Ryan A. Romans [Opens in a new window] ,
Wendy Whiteside ,
Sunkyung Yu ,
Lori Harris ,
Veronika Dottermann  and
Jeffrey D. Zampi
Ryan A. Romans*
Affiliation:
Department of Cardiology, Children’s Mercy Kansas City and Ward Family Heart Center, Kansas City, MO, USA
Wendy Whiteside
Affiliation:
Division of Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital and University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
Sunkyung Yu
Affiliation:
Division of Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital and University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
Lori Harris
Affiliation:
Division of Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital and University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
Veronika Dottermann
Affiliation:
Division of Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital and University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
Jeffrey D. Zampi
Affiliation:
Division of Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital and University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
*
Author for correspondence: Ryan Romans, MD, Department of Cardiology, 2401 Gillham Road, Children’s Mercy Kansas City and Ward Family Heart Center, Kansas City, MO64108, USA. Tel: +(816) 302-3649; Fax: (816) 302-9987. E-mail: raromans@cmh.edu
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Abstract

Objectives:

Assess the acute and short-term haemodynamic impact of transcatheter pulmonary valve implantation on left ventricular systolic and diastolic function stratified by pre-transcatheter pulmonary valve implantation physiology.

Background:

Transcatheter pulmonary valve implantation is a widely available option to treat residual or recurrent pulmonary stenosis and pulmonary insufficiency. Transcatheter pulmonary valve implantation acutely increases pulmonary artery size and diastolic pressure in patients with pulmonary insufficiency and acute pulmonary edema has been reported after transcatheter pulmonary valve implantation, possibly related to acute left ventricular volume loading. However, the impact of transcatheter pulmonary valve implantation on left ventricular diastolic function has not been established.

Methods:

Patients who underwent transcatheter pulmonary valve implantation from 2010 to 2017 at our centre were grouped by indication for transcatheter pulmonary valve implantation as pulmonary stenosis, pulmonary insufficiency, or mixed disease. Separate analysis was performed on those who underwent transcatheter pulmonary valve implantation for pulmonary stenosis versus pulmonary insufficiency or mixed disease. Intracardiac haemodynamics immediately before and after transcatheter pulmonary valve implantation and echocardiographic assessment of left ventricular systolic and diastolic function at baseline, 1-day post transcatheter pulmonary valve implantation, and 1-year post transcatheter pulmonary valve implantation were compared between groups.

Results:

In 102 patients who underwent transcatheter pulmonary valve implantation, the indication was pulmonary stenosis in 29 (28%), pulmonary insufficiency in 28 (29%), and mixed disease in 44 (43%). There were no significant differences in left ventricular systolic or diastolic function between groups at baseline, immediately after transcatheter pulmonary valve implantation, or 1-year post implantation. The mean pulmonary artery wedge pressure increased equally across groups.

Conclusions:

While patients with pulmonary insufficiency likely have acute left ventricular volume loading following transcatheter pulmonary valve implantation, this does not appear to be haemodynamically significant as transcatheter pulmonary valve implantation was not associated with measurable changes in left ventricular systolic or diastolic function acutely or 1-year post implantation.

Keywords

Cardiac catheterisationheart valve prosthesis implantationtranscatheter pulmonary valve implantationcongenital heart defects
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 11 , November 2021 , pp. 1835 - 1841
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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