title: The Effects of Pulmonary Valve Replacement for Severe Pulmonary Regurgitation on Exercise Capacity and Cardiac Function.
abstract: Patients may develop hemodynamic abnormalities after right ventricular outflow tract (RVOT) repair. Re-intervention timing remains a dilemma. This study evaluates exercise capacity and RV function before and after intervention using age-related comparisons. Twenty-six patients with severe pulmonary regurgitation (PR) after initial repair scheduled for pulmonary valve replacement (PVR) were enrolled. Metabolic treadmill testing (EST) and MRI were obtained before and after surgery. EST results were compared with matched controls. Preoperative exercise time and peak oxygen consumption (VO2 max) were significantly diminished compared with controls but were not significantly different postoperatively. The patients were then split into age-related cohorts. When comparing pre-PVR and post-PVR exercise time and VO2 max among themselves, neither cohort showed significant differences. However, patients younger than 25 years had better postoperative results, an age-related difference not seen in the controls. Preoperative MRI showed significantly dilated RV, PR, and low normal function. After PVR, the right to left ventricular end-diastolic volume ratio (RVEDV:LVEDV) and pulmonary artery regurgitant fraction (RF) significantly decreased. There was no change in ventricular ejection fractions (EF). Severe PR, decreased RVEF, and RV dilation can significantly diminish exercise capacity. PVR improves RVEDV:LVEDV and RF, but not EF. Younger patients had better exercise capacity that was maintained postoperatively. This age-related difference was not seen in the controls, indicating that earlier intervention may preserve exercise capacity. Serial ESTs in patients with severe PR following RVOT repair may identify deteriorating exercise capacity as an early indicator for the need for PVR.
authors.affiliation: Section of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, 699 Riley Hospital Drive, RR 127, Indianapolis, IN, 46202, USA, Jasong.ho@gmail.com.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Ho
authors.forename: Marcus S
authors.initials: MS
authors.lastname: Schamberger
authors.forename: Roger A
authors.initials: RA
authors.lastname: Hurwitz
authors.forename: Tiffanie R
authors.initials: TR
authors.lastname: Johnson
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Sterrett
authors.forename: Eric S
authors.initials: ES
authors.lastname: Ebenroth
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D011184:Postoperative Period; D057234:Preoperative Period; D011664:Pulmonary Valve / Q000473:pathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000473:pathology / Q000601:surgery*; D013771:Tetralogy of Fallot / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology*