Echocardiographic assessment of diastolic biventricular properties in patients operated for severe pulmonary regurgitation and association with exercise capacity.
OBJECTIVE
We aimed to assess the impact of surgical pulmonary valve replacement (PVR) for severe pulmonary regurgitation (PR) on biventricular function and its effect on exercise capacity.


RESULTS
Seventy-three patients (mean age 23.6±11.5 years, 47 females) underwent surgical PVR for PR. Echocardiogram and magnetic resonance imaging to assess ventricular size and function, and a cardiopulmonary exercise test were performed before, and 1-year post-surgery. Median New York Heart Association class improved from 2 to 1 but peak oxygen uptake (VO2) did not change. Left ventricular (LV) cardiac output increased from 3.2±0.9 to 3.5±0.7 L/min (P=0.003). However, this was not associated with increased trans-mitral velocities (▵E=-0.13, P=0.004; ▵A=0.03, P=0.395), or increased heart rate (-0.002%, P=0.993). Trans-tricuspid rapid right ventricular (RV) filling increased significantly, whereas early diastolic myocardial velocity in RV wall decreased (E velocity: 0.57±0.14-0.65±0.21, P=0.034; and E/e' from 6.7±1.9 to 14.8±7.0, P<0.0001). RV and LV late diastolic velocities and their ratio to early velocities (A, a', E/A, and e'/a') correlated with pre- and/or post-PVR peak VO2. No correlations were found between indexes of systolic function and peak VO2, either before or after surgery. Doppler evidence of restrictive RV physiology resolved after elimination of PR.


CONCLUSIONS
Surgical PVR for PR improves RV filling and increases left ventricular stroke volume, however, this could not be demonstrated by conventional Doppler echocardiography. Diastolic ventricular function was associated with exercise capacity. Because of its load dependency, E/e' ratio failed in assessing diastolic function. Pre-systolic flow in pulmonary trunk in presence of severe PR does not determine intrinsic myocardial stiffness.
Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. alessandra.frigiola@gmail.com
Alessandra
A
Frigiola
Alessandro
A
Giardini
Andrew
A
Taylor
Victor
V
Tsang
Graham
G
Derrick
Sachin
S
Khambadkone
Fiona
F
Walker
Shay
S
Cullen
Philipp
P
Bonhoeffer
Jan
J
Marek
D016009:Chi-Square Distribution; D003971:Diastole; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult