title: Preprocedural Risk Assessment Prior to PPVI with CMR and Cardiac CT.
abstract: Percutaneous pulmonary valve intervention (PPVI) is a less invasive and less costly approach to pulmonary valve replacement compared with the surgical alternative. Potential complications of PPVI include coronary compression and pulmonary arterial injury/rupture. The purpose of this study was to characterize the morphological risk factors for PPVI complication with cardiac MRI and cardiac CTA. A retrospective review of 88 PPVI procedures was performed. 44 patients had preprocedural cardiac MRIs or CTAs available for review. Multiple morphological variables on cardiac MRI and CTA were compared with known PPVI outcome and used to investigate associations of variables in determining coronary compression or right ventricular-pulmonary arterial conduit injury. The most significant risk factor for coronary artery compression was the proximity of the coronary arteries to the conduit. In all patients with coronary compression during PPVI, the coronary artery touched the conduit on the preprocedural CTA/MRI, whilst in patients without coronary compression the mean distance between the coronary artery and the conduit was 4.9 mm (range of 0.8-20 mm). Multivariable regression analysis demonstrated that exuberant conduit calcification was the most important variable for determining conduit injury. Position of the coronary artery directly contacting the conduit without any intervening fat may predict coronary artery compression during PPVI. Exuberant conduit calcification increases the risk of PPVI-associated conduit injury. Close attention to these factors is recommended prior to intervention in patients with pulmonary valve dysfunction.
authors.affiliation: Department of Radiology, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Ladonna
authors.initials: L
authors.lastname: Malone
authors.affiliation: Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Fonseca
authors.affiliation: University of Tennessee Health Sciences Center, Aurora, Colorado, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fagan
authors.affiliation: Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Gralla
authors.affiliation: Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Wilson
authors.forename: Daniel
authors.initials: D
authors.lastname: Vargas
authors.affiliation: Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Micheal
authors.initials: M
authors.lastname: DiMaria
authors.affiliation: Department of Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Uyen
authors.initials: U
authors.lastname: Truong
authors.affiliation: Department of Radiology, Children's Hospital Colorado, Aurora, Colorado, USA. lorna.browne@childrenscolorado.org.
authors.forename: Lorna P
authors.initials: LP
authors.lastname: Browne
mesh_terms: D000293:Adolescent; D000328:Adult; D002114:Calcinosis / Q000209:etiology; D002648:Child; D003324:Coronary Artery Disease / Q000209:etiology; D006321:Heart / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008875:Middle Aged; D011300:Preoperative Care; D011664:Pulmonary Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Cardiac CT; Cardiac MRI; Coronary compression; Percutaneous pulmonary valve; Tetralogy of Fallot