Immediate clinical and haemodynamic benefits of restoration of pulmonary valvar competence in patients with pulmonary hypertension.
OBJECTIVE
To analyse the potential benefit of restoration of pulmonary valvar competence in patients with severe pulmonary regurgitation (PR) and pulmonary hypertension (PH) associated with congenital heart disease.


METHODS
Retrospective study.


METHODS
Tertiary paediatric and adult congenital heart cardiac centre.


METHODS
Percutaneous pulmonary valve implantation (PPVI).


METHODS
All patients who underwent PPVI for treatment of PR in the presence of PH (mean PAP >25 mm Hg).


RESULTS
Seven patients with severe PH as a result of congenital heart disease and severe PR underwent PPVI. The valve implantation procedure was feasible and uncomplicated in all seven cases, successfully abolishing PR. There was a significant increase in diastolic (15.4 (7.3) to 34.0 (8.5) mm Hg; p = 0.007) and mean (29.7 (8.1) to 41.3 (12.9) mm Hg; p = 0.034) pulmonary artery pressures, and an improvement in NYHA functional class (from median IV to median III; p<0.008). Peripheral oxygen saturations rose from 85.9% (11.0%) to 91.7% (8.3%) (p = 0.036). Right ventricular (RV) volumes decreased (from 157.0 (44.7) to 140.3 (53.3) ml/m(2)), while effective RV stroke volume increased (from 23.4 (9.3) to 41.0 (11.6) ml/m(2)). During a median follow-up of 20.3 months (range 1.3-47.5), valvar competence was well maintained despite near systemic pulmonary pressures. None of the valved stents were explanted during follow-up.


CONCLUSIONS
Trans-catheter treatment of PR in patients with PH is well tolerated and leads to clinical and haemodynamic improvement, most probably caused by a combination of increased pulmonary perfusion pressures and RV efficiency.
Lurz
P
P
Cardiac Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK.
Nordmeyer
J
J
Coats
L
L
Taylor
A M
AM
Bonhoeffer
P
P
Schulze-Neick
I
I