title: Right ventricular remodelling after transcatheter pulmonary valve implantation.
abstract: OBJECTIVE
  To define the optimal timing for percutaneous pulmonary valve implantation (PPVI) in patients with severe pulmonary regurgitation (PR) after Fallot's Tetralogy (ToF) correction.
  
  
  BACKGROUND
  PPVI among the aforementioned patients is mainly driven by symptoms or by severe right ventricular (RV) dilatation/dysfunction. The optimal timing for PPVI is still disputed.
  
  
  METHODS
  Twenty patients [age 13.9 ± 9.2 years, (range 4.3-44.9), male 70%] with severe PR (≥3 grade) secondary to previous correction of ToF, underwent Melody valve (Medtronic, Minneapolis, MN) implantation, after a pre-stent placement. Full echocardiographic assessment (traditional and deformation analysis) and cardiovascular magnetic resonance evaluation were performed before and at 3 months after the intervention. 'Favorable remodelling' was considered the upper quartile of RV size decrease (>20% in 3 months).
  
  
  RESULTS
  After PPVI, indexed RV effective stroke volume increased from 38.4 ± 9.5 to 51.4 ± 10.7 mL/m2, (P = 0.005), while RV end-diastolic volume and strain indices decreased (123.1 ± 24.1-101.5 ± 18.3 mL/m2, P = 0.005 and -23.5 ± 2.5 to -21 ± 2.5%, P = 0.002, respectively). After inserting pre-PPVI clinical, RV volumetric and deformation parameters in a multiple regression model, only time after last surgical correction causing PR remained as significant regressor of RV remodelling [R2= 0.60, beta = 0.387, 95%CI(0.07-0.7), P = 0.019]. Volume reduction and functional improvement were more pronounced in patients treated with PPVI earlier than 7 years after last RV outflow tract (RVOT) correction, reaching close-to-normal values.
  
  
  CONCLUSIONS
  Early PPVI (<7 years after last RVOT operation) is associated with a more favorable RV reverse remodelling toward normal range and should be considered, before symptoms or RV damage become apparent. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Efstathios D
authors.identifier: http://orcid.org/0000-0003-0189-8353
authors.initials: ED
authors.lastname: Pagourelias
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Daraban
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Razvan O
authors.initials: RO
authors.lastname: Mada
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Duchenne
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Oana
authors.initials: O
authors.lastname: Mirea
authors.affiliation: Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Cools
authors.affiliation: Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Ruth
authors.initials: R
authors.lastname: Heying
authors.affiliation: Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Derize
authors.initials: D
authors.lastname: Boshoff
authors.affiliation: Department of Radiology, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Bogaert
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.affiliation: Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
authors.affiliation: Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Voigt
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling; D055815:Young Adult
keywords: congenital heart disease adults; imaging TEE/TTE; imaging cardiac magnetic resonance imaging; right ventricular function; transcatheter valve implantation