title: Early echocardiographic changes after percutaneous implantation of the Edwards SAPIEN transcatheter heart valve in the pulmonary position.
abstract: OBJECTIVE
  To evaluate echocardiographic changes after SAPIEN valve implantation in the pulmonary position.
  
  
  BACKGROUND
  The feasibility of the SAPIEN transcatheter pulmonary valve (TPV) has recently been demonstrated. We evaluated changes in pulmonary valve function and the right ventricle after SAPIEN TPV placement.
  
  
  METHODS
  We evaluated echocardiograms at baseline, discharge, 1 and 6 months after TPV placement in 33 patients from 4 centers. Pulmonary insufficiency severity was graded 0-4. TPV peak and mean gradients were measured. Right ventricular (RV) size and function were quantified using routine measures derived from color, spectral, and tissue Doppler indices and two-dimensional echocardiography.
  
  
  RESULTS
  At baseline, 94% patients demonstrated pulmonary insufficiency grade 2-4. This decreased to 12% patients at 6 months (P < 0.01). TPV peak (P < 0.01) and mean gradient (P < 0.01) decreased. RV end-diastolic area indexed to body surface area (BSA) (P < 0.01), Tricuspid regurgitation (TR) gradient (P < 0.01), and the ratio of TR jet area to BSA (P < 0.01) decreased. Tricuspid inflow peak E:A, tissue Doppler imaging (TDI): septal E' and A', TDI: tricuspid A' improved between baseline and discharge, but trended back to baseline by 6-month follow-up. Tricuspid valve annulus z-score, RV area change, tricuspid annular plane systolic excursion (TAPSE), RV dP/dt, tricuspid E:E', and TDI: tricuspid annulus E' showed no change.
  
  
  CONCLUSIONS
  Improvements in pulmonary insufficiency and stenosis, RV size, and TR gradient and severity are seen after SAPIEN TPV placement. Selected indices of RV diastolic function improve immediately after TPV implantation, but return to baseline by 6 months. RV systolic function is unchanged.
authors: Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA. chowdhur@musc.edu
authors: Shahryar M
authors: SM
authors: Chowdhury
authors: Ziyad M
authors: ZM
authors: Hijazi
authors: John
authors: J
authors: Rhodes
authors: Saibal
authors: S
authors: Kar
authors: Raj
authors: R
authors: Makkar
authors: Michael
authors: M
authors: Mullen
authors: Qi-Ling
authors: QL
authors: Cao
authors: Lydia
authors: L
authors: King
authors: Jodi
authors: J
authors: Akin
authors: Girish
authors: G
authors: Shirali
mesh_terms: D000328:Adult; D062906:Cardiac Catheters; D004452:Echocardiography; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States
keywords: congenital heart disease; echocardiography; percutaneous intervention; pulmonary regurgitation; pulmonary valve; right ventricle