Ventricular remodelling after pulmonary valve replacement: comparison between pressure-loaded and volume-loaded right ventricles.
OBJECTIVE
In patients with severe pulmonary valve regurgitation or stenosis, pulmonary valve replacement (PVR) has a favourable effect on right ventricular (RV) volume and pressure unloading. PVR thereby decreases the progression of RV dilatation and/or hypertrophy. This study investigates RV remodelling patterns after PVR in patients with either pressure, volume or combined volume- and pressure-loaded RVs.


METHODS
We evaluated 79 consecutive patients who had undergone PVR, between 1999 and 2012 beyond the age of 14 years. Comparisons were made according to the RV loading condition, i.e. isolated volume-loaded (iPR, n = 53), combined volume- and pressure-loaded (cPR/[PS] pulmonary stenosis, n = 16), and isolated pressure-loaded RVs (iPS n = 10). The main study outcome was the change of the RV end-diastolic diameter (ΔRVEDD) before and after PVR, measured on echocardiography.


RESULTS
The majority of patients (65%) had a tetralogy of Fallot. After PVR, the RVEDD decreased with 5.3 mm/m(2), body surface area (BSA) (P < 0.001). In addition, the RV end-diastolic volume on cardiac magnetic resonance declines with 40 ml/m(2), BSA (P < 0.001). The change in the RVEDD after PVR was different according to the loading condition (i.e. iPR: -6.6, cPR/PS: -4.7 and iPS: +0.4 mm/m(2), P < 0.001). In a multivariate regression model, pressure load remained a significant predictor of decreased RVEDD (P = 0.005).


CONCLUSIONS
The current data indicate that the type of right ventricular loading (pressure versus volume) before PVR affects the RV remodelling pattern after PVR. Right ventricular pressure load has an adverse effect on early RV remodelling after PVR.
Department of Pediatric Cardiology, Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Netherlands tm.gorter@umcg.nl.
Thomas M
TM
Gorter
Department of Cardiology, Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Netherlands.
Joost P
JP
van Melle
Department of Epidemiology, Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Netherlands.
Hans L
HL
Hillege
Department of Cardiology, Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Netherlands.
Petronella G
PG
Pieper
Department of Cardiothoracic Surgery, Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Netherlands.
Tjark
T
Ebels
Department of Cardiology, Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Netherlands.
Elke S
ES
Hoendermis
Department of Pediatric Cardiology, Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Netherlands.
Beatrijs
B
Bartelds
Department of Radiology, Center for Congenital Heart Diseases, University Medical Center Groningen, University of Groningen, Netherlands.
Tineke P
TP
Willems
Department of Pediatric Cardiology, Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Netherlands.
Rolf M F
RM
Berger
D000293:Adolescent; D000328:Adult; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016278:Ventricular Function, Right; D017725:Ventricular Pressure; D020257:Ventricular Remodeling; D055815:Young Adult
Right ventricular remodelling after PVR