Current approaches to pulmonary regurgitation.
OBJECTIVE
To evaluate the effects on ventricular function and volumes following right ventricular outflow tract reconstruction (RVOTR) with pulmonary homograft replacement (PVR) and percutaneous pulmonary valve implantation (PPVI) for predominant pulmonary regurgitation. This study was not intended to compare the two approaches.


METHODS
We prospectively examined 25 patients (mean age 21+/-13 years, 96% tetralogy of Fallot, 1/25 with conduit dysfunction) who had PVR with RVOTR for severe pulmonary regurgitation (PR), and 11 patients (mean age 20+/-9 years, 64% tetralogy of Fallot, 9/11 with conduit dysfunction) who underwent PPVI for predominant PR. Mean age at primary repair in both groups was 4.3+/-6.6 years. Magnetic resonance imaging was performed prior to, and 1 year following, interventions.


RESULTS
Before procedure, NYHA classification was similar in both groups 2.1+/-0.5. Following interventions, there was a significant reduction in RV volumes in both groups. In the surgical (PVR) group, RV end-diastolic volume (EDV) decreased from 151+/-49 to 97+/-32 ml/m(2) (p<0.0001) whereas end-systolic volume (ESV) decreased from 80+/-43 to 46+/-23 ml/m(2) (p<0.0001). In the PPVI group, RV EDV decreased from 106+/-27 to 89+/-25 ml/m(2) (p=0.002) and RV ESV from 49+/-20 to 40+/-16 ml/m(2) (p=0.034). Both groups had a significant improvement in RV (63+/-20 to 72+/-16 ml/beat, p=0.003 (PVR group), 53+/-14 to 67+/-16 ml/beat, p=0.030 (PPVI group)) and LV effective stroke volume (61+/-18 to 73+/-16 ml/beat, p=0.001 (PVR group); 59+/-24 to 75+/-16 ml/beat, p=0.009 (PPVI group)).


CONCLUSIONS
Following either PVR with RVOTR or PPVI, there was a significant reduction in RV volumes and an improvement in RV function. Importantly, in both groups, LV effective SV increased, and this may be the parameter to judge the benefit of the procedure. These results also support PPVI as an extra dimension in complex RVOT management.
Great Ormond Street Hospital for Children, London, United Kingdom.
Alessandra
A
Frigiola
Victor
V
Tsang
Johannes
J
Nordmeyer
Philipp
P
Lurz
Carin
C
van Doorn
Andrew M
AM
Taylor
Philipp
P
Bonhoeffer
Mark
M
de Leval
D000293:Adolescent; D000328:Adult; D002648:Child; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000601:surgery; D016277:Ventricular Function, Left / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology; D055815:Young Adult