title: Restrictive right ventricular performance assessed by cardiac magnetic resonance after balloon valvuloplasty of critical pulmonary valve stenosis.
abstract: BACKGROUND
  Little data are published about right ventricular diastolic performance in patients with critical pulmonary valve stenosis after balloon pulmonary valvuloplasty thus far.
  
  
  METHODS
  A total of 44 patients with isolated critical pulmonary valve stenosis who had undergone balloon valvuloplasty with haemodynamic recordings were enrolled to the study; 33 patients who came for follow-up underwent further imaging by echocardiography after 6 months and their right ventricular functional parameters were compared with 33 control patients of the same age and sex. Out of 33 patients, 21 underwent cardiac MRI with late gadolinium enhancement to assess the presence of right ventricular fibrosis.
  
  
  RESULTS
  The right ventricular systolic pressure (p<0.0001) and right ventricular outflow tract gradient (p<0.0001) decreased acutely (p<0.0001) after balloon valvuloplasty. During follow-up, M-mode left ventricular end diastolic dimension (p<0.001) and end systolic dimension increased (p<0.001), whereas right ventricular end diastolic dimension decreased (p<0.001). Compared with controls, patients (n=33) had significantly reduced tricuspid annular Ea and higher E/Ea (p<0.001). Right ventricular systolic dysfunction was also suggested by reduced tricuspid annular systolic velocity (p<0.001). Late gadolinium enhancement was demonstrated in 13 out of 21 patients with restrictive physiology, which involves the anterior right ventricular outflow tract, anterior wall, and inferior wall. The right ventricular late gadolinium enhancement score correlated positively with age (r=0.7, p<0.001) and right ventricular mass index (r=0.52, p<0.001).
  
  
  CONCLUSIONS
  The persistence of right ventricular diastolic dysfunction after relief of chronic pressure overload of critical pulmonary valve stenosis suggests that a factor - other than increase in afterload - is involved in this physiology. Fibrosis is the most likely factor responsible for persistence of restrictive physiology as documented by late gadolinium enhancement.
authors.affiliation: Department of Pediatric Cardiology,National Heart Institute,Imbaba,Giza,Egypt.
authors.forename: Ikram
authors.initials: I
authors.lastname: Massoud
authors.affiliation: Department of Pediatric Cardiology,National Heart Institute,Imbaba,Giza,Egypt.
authors.forename: Nader
authors.initials: N
authors.lastname: Botros
authors.affiliation: Department of Pediatric Cardiology,National Heart Institute,Imbaba,Giza,Egypt.
authors.forename: Atef
authors.initials: A
authors.lastname: Yehia
authors.affiliation: Department of Pediatric Cardiology,National Heart Institute,Imbaba,Giza,Egypt.
authors.forename: Hassan
authors.initials: H
authors.lastname: Abdelghafoor
authors.affiliation: Department of Pediatric Cardiology,National Heart Institute,Imbaba,Giza,Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Donya
authors.affiliation: Department of Pediatric Cardiology,National Heart Institute,Imbaba,Giza,Egypt.
authors.forename: Ahmd
authors.initials: A
authors.lastname: Samir
authors.forename: Heba
authors.initials: H
authors.lastname: Serag
authors.affiliation: Department of Pediatric Cardiology,National Heart Institute,Imbaba,Giza,Egypt.
authors.forename: Elham
authors.initials: E
authors.lastname: Mohamed
mesh_terms: D000293:Adolescent; D000328:Adult; D063126:Balloon Valvuloplasty; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D003971:Diastole; D015150:Echocardiography, Doppler; D004534:Egypt; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D013599:Systole; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Restrictive right ventricular physiology; late gadolinium enhancement; tissue Doppler