title: Usefulness of maximal oxygen pulse in timing of pulmonary valve replacement in patients with isolated pulmonary regurgitation.
abstract: Patients with pulmonary regurgitation after tetralogy of Fallot repair have impaired aerobic capacity; one of the reasons is the decreasing global ventricular performance at exercise, reflected by decreasing peak oxygen pulse. The aims of our study were to evaluate the impact of pulmonary valve replacement on peak oxygen pulse in a population with pure pulmonary regurgitation and with different degrees of right ventricular dilatation and to determine the predictors of peak oxygen pulse after pulmonary valve replacement. The mean and median age at pulmonary valve replacement was 27 years. Mean pre-procedural right ventricular end-diastolic volume was 182 ml/m2. Out of 24 patients, 15 had abnormal peak oxygen pulse before pulmonary valve replacement. We did not observe a significant increase in peak oxygen pulse after pulmonary valve replacement (p=0.76). Among cardiopulmonary test/MRI/historical pre-procedural parameters, peak oxygen pulse appeared to be the best predictor of peak oxygen pulse after pulmonary valve replacement (positive and negative predictive values, respectively, 0.94 and 1). After pulmonary valve replacement, peak oxygen pulse was well correlated with left ventricular stroke and end-diastolic volumes (r=0.67 and 0.68, respectively). Our study confirms the absence of an effect of pulmonary valve replacement on peak oxygen pulse whatever the initial right ventricular volume, reflecting possible irreversible right and/or left ventricle lesions. Pre-procedural peak oxygen pulse seemed to well predict post-procedural peak oxygen pulse. These results encourage discussions on pulmonary valve replacement in patients showing any decrease in peak oxygen pulse during their follow-up.
authors.affiliation: 1Pediatric Cardiology, Centre de référence des malformations cardiaques congénitales complexes-M3C,Necker hospital for sick children,Assistance publique des Hôpitaux de Paris,Paris,France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Legendre
authors.affiliation: 2Department of Sport Medicine and Functional Explorations,CHU Clermont-Ferrand and INRA UMR 1019,CRNH-Auvergne,Clermont-Ferrand,Paris,France.
authors.forename: Ruddy
authors.initials: R
authors.lastname: Richard
authors.affiliation: 3Adult Congenital Heart Disease Unit,Cardiology Department,Hôpital Européen Georges Pompidou,Centre de référence des Malformations Cardiaques Congénitales Complexes,M3C, Assistance Publique-Hôpitaux de Paris,Paris,France.
authors.forename: Florence
authors.initials: F
authors.lastname: Pontnau
authors.affiliation: 4Paris-Descartes University, Faculty of Medicine,Department of Biostatistics and Medical Informatics,Assistance Publique-Hôpitaux de Paris,Necker hospital for sick children, Faculte de Medecine Necker Enfants Malades,Paris,France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Jais
authors.affiliation: 5Department of Cardiology, Hôpital Européen Georges Pompidou,Assistance Publique des Hôpitaux de Paris, Paris, France;Department of Cardiology,Hôpital Européen Georges Pompidou,Paris,France.
authors.forename: Marc
authors.initials: M
authors.lastname: Dufour
authors.affiliation: 5Department of Cardiology, Hôpital Européen Georges Pompidou,Assistance Publique des Hôpitaux de Paris, Paris, France;Department of Cardiology,Hôpital Européen Georges Pompidou,Paris,France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Grenier
authors.affiliation: 6Department of Cardiovascular Radiology,Hôpital Européen Georges Pompidou and INSERM U970,Paris-Descartes University,Paris Descartes University,Paris,France.
authors.forename: Elie
authors.initials: E
authors.lastname: Mousseaux
authors.affiliation: 1Pediatric Cardiology, Centre de référence des malformations cardiaques congénitales complexes-M3C,Necker hospital for sick children,Assistance publique des Hôpitaux de Paris,Paris,France.
authors.forename: Magalie
authors.initials: M
authors.lastname: Ladouceur
authors.affiliation: 3Adult Congenital Heart Disease Unit,Cardiology Department,Hôpital Européen Georges Pompidou,Centre de référence des Malformations Cardiaques Congénitales Complexes,M3C, Assistance Publique-Hôpitaux de Paris,Paris,France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Iserin
authors.affiliation: 1Pediatric Cardiology, Centre de référence des malformations cardiaques congénitales complexes-M3C,Necker hospital for sick children,Assistance publique des Hôpitaux de Paris,Paris,France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005080:Exercise Test; D005260:Female; D005602:France; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000737:chemistry*; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000150:complications*; D016278:Ventricular Function, Right; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: CHD; cardiopulmonary exercise test; oxygen pulse; pulmonary valve replacement