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Zhou Z, Huang Y, Han L, Zhang Y, Zhao J, Wen S, Chen J. Right ventricular dilatation score: a new assessment to right ventricular dilatation in adult patients with repaired tetralogy of Fallot. BMC Cardiovasc Disord 2023; 23:458. [PMID: 37710173 PMCID: PMC10500856 DOI: 10.1186/s12872-023-03487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (rTOF) experience long-term chronic pulmonary valve regurgitation resulting in right ventricular (RV) dilatation. According to current guidelines, the evaluation of patients with rTOF for RV dilatation should be based on cardiac magnetic resonance (CMR). However, for many asymptomatic patients, routine CMR is not practical. Our study aims to identify screening methods for CMR based on echocardiographic data, with the goal of establishing a more practical and cheap method of screening for severity of RV dilatation in patients with asymptomatic rTOF. METHODS Thirty two rTOF patients (mean age, 21(10.5) y, 21 males) with moderate to severe pulmonary regurgitation (PR) were prospectively recruited. Each patient received CMR and echocardiogram examination within 1 month prior to operation and collected clinical data, and then received echocardiogram examination at discharge and 3-6 months post-surgery. RESULTS RV moderate-severe dilatation was defined as right ventricular end-diastolic volume index (RVEDVI) ≥ 160 ml/m2 or right ventricular end-systolic volume index (RVESVI) ≥ 80 ml/m2 in 15 of 32 patients (RVEDVI, 202.15[171.51, 252.56] ml/m2, RVESVI, 111.99 [96.28, 171.74] ml/m2). The other 17 (RVESDI, 130.19 [117.91, 139.35] ml/m2, RVESVI = 67.91 [63.35, 73.11] ml/m2) were defined as right ventricle mild dilatation, i.e., RVEDVI < 160 ml/m2 and RVESVI < 80 ml/m2, and the two parameters were higher than normal values. Compared with the RV mild dilatation group, patients of RV moderate-severe dilatation have worse cardiac function before surgery (right ventricular ejection fraction, 38.92(9.19) % versus 48.31(5.53) %, p < 0.001; Left ventricular ejection fraction, 59.80(10.26) versus 66.41(4.15), p = 0.021). Patients with RV moderate-severe dilatation faced longer operation time and more blood transfusion during operation (operation time, 271.53(08.33) min versus 170.53(72.36) min, p < 0.01; Intraoperative blood transfusion, 200(175) ml versus 100(50) ml, p = 0.001). Postoperative RV moderate-severe dilatation patients have poor short-term prognosis, which was reflected in a longer postoperative hospital stay (6.59 [2.12] days versus 9.80 [5.10] days, p = 0.024) and a higher incidence of hypohepatia (0[0] % versus 4[26.7] %, p = 0.023). Patients with RV dilatation score > 2.35 were diagnosed with RV moderate-severe dilatation (AUC = 0,882; Sensitivity = 94.1%; Specificity = 77.3%). CONCLUSIONS RV moderate-severe dilatation is associated with worse preoperative cardiac function and short-term prognosis after PVR in rTOF patients with moderate to severe PR. The RV dilatation score is an effective screening method. When RV dilatation score > 2.35, the patient is indicated for further CMR examination and treatment.
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Affiliation(s)
- Ziqin Zhou
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Ying Huang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Linjiang Han
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Yong Zhang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Junfei Zhao
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China.
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Harrington JK, Ghelani S, Thatte N, Valente AM, Geva T, Graf JA, Lu M, Sleeper LA, Powell AJ. Impact of pulmonary valve replacement on left ventricular rotational mechanics in repaired tetralogy of Fallot. J Cardiovasc Magn Reson 2021; 23:61. [PMID: 34024274 PMCID: PMC8142485 DOI: 10.1186/s12968-021-00750-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In repaired tetralogy of Fallot (rTOF), abnormal left ventricular (LV) rotational mechanics are associated with adverse clinical outcomes. We performed a comprehensive analysis of LV rotational mechanics in rTOF patients using cardiac magnetic resonance (CMR) prior to and following surgical pulmonary valve replacement (PVR). METHODS In this single center retrospective study, we identified rTOF patients who (1) had both a CMR ≤ 1 year before PVR and ≤ 5 years after PVR, (2) had no other intervening procedure between CMRs, (3) had a body surface area > 1.0 m2 at CMR, and (4) had images suitable for feature tracking analysis. These subjects were matched to healthy age- and sex-matched control subjects. CMR feature tracking analysis was performed on a ventricular short-axis stack of balanced steady-state free precession images. Measurements included LV basal and apical rotation, twist, torsion, peak systolic rates of rotation and torsion, and timing of events. Associations with LV torsion were assessed. RESULTS A total of 60 rTOF patients (23.6 ± 7.9 years, 52% male) and 30 healthy control subjects (20.8 ± 3.1 years, 50% male) were included. Compared with healthy controls, rTOF patients had lower apical and basal rotation, twist, torsion, and systolic rotation rates, and these parameters peaked earlier in systole. The only parameters that were correlated with LV torsion were right ventricular (RV) end-systolic volume (r = - 0.28, p = 0.029) and RV ejection fraction (r = 0.26, p = 0.044). At a median of 1.0 year (IQR 0.5-1.7) following PVR, there was no significant change in LV rotational parameters versus pre-PVR despite reductions in RV volumes, RV mass, pulmonary regurgitation, and RV outflow tract obstruction. CONCLUSION In this comprehensive study of CMR-derived LV rotational mechanics in rTOF patients, rotation, twist, and torsion were diminished compared to controls and did not improve at a median of 1 year after PVR despite favorable RV remodeling.
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Affiliation(s)
- Jamie K Harrington
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Department of Pediatrics, Division of Cardiology, College of Physicians and Surgeons, Columbia University, 3959 Broadway, CHN 2, New York, NY, 10032, USA.
| | - Sunil Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Nikhil Thatte
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Julia A Graf
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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D'Souza GA, Banerjee RK, Taylor MD. Evaluation of pulmonary artery stenosis in congenital heart disease patients using functional diagnostic parameters: An in vitro study. J Biomech 2018; 81:58-67. [PMID: 30293825 DOI: 10.1016/j.jbiomech.2018.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/23/2018] [Accepted: 09/13/2018] [Indexed: 02/03/2023]
Abstract
Congenital pulmonary artery (PA) stenosis is often associated with abnormal PA hemodynamics including increased pressure drop (Δp) and reduced asymmetric flow (Q), which may result in right ventricular dysfunction. We propose functional diagnostic parameters, pressure drop coefficient (CDP), energy loss (Eloss), and normalized energy loss (E¯loss) to characterize pulmonary hemodynamics, and evaluate their efficacy in delineating stenosis severity using in vitro experiments. Subject-specific test sections including the main PA (MPA) bifurcating into left and right PAs (LPA, RPA) with a discrete LPA stenosis were manufactured from cross-sectional imaging and 3D printing. Three clinically-relevant stenosis severities, 90% area stenosis (AS), 80% AS, and 70% AS, were evaluated at different cardiac outputs (COs). A benchtop flow loop simulating pulmonary hemodynamics was used to measure Q and Δp within the test sections. The experimental Δp-Q characteristics along with clinical data were used to obtain pathophysiologic conditions and compute the diagnostic parameters. The pathophysiologic QLPA decreased as the stenosis severity increased at a fixed CO. CDPLPA, Eloss,LPA (absolute), and E¯loss,LPA (absolute) increased with an increase in LPA stenosis severity at a fixed CO. Importantly, CDPLPA and E¯loss,LPA had reduced variability with CO, and distinct values for each LPA stenosis severity. Under variable CO, a) CDPLPA values were 14.5-21.0 (70% AS), 60.7- 2.2 (80% AS), ≥ 261.6 (90% AS), and b) E¯loss,LPA values (in mJ per QLPA) were -501.9 to -1023.8 (70% AS), -1247.6 to -1773.0 (80% AS), -1934.5 (90% AS). Hence, CDPLPA and E¯loss,LPA are expected to assess the true functional severity of PA stenosis.
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Affiliation(s)
- Gavin A D'Souza
- Department of Mechanical and Materials Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Rupak K Banerjee
- Department of Mechanical and Materials Engineering, University of Cincinnati, Cincinnati, OH, USA.
| | - Michael D Taylor
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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D'Souza GA, Taylor MD, Banerjee RK. Evaluation of pulmonary artery wall properties in congenital heart disease patients using cardiac magnetic resonance. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Yamada M, Takahashi K, Kobayashi M, Yazaki K, Takayasu H, Akimoto K, Kishiro M, Inage A, Yoshikawa T, Park IS, Nakanishi K, Kawasaki S, Shimizu T. Mechanisms of Left Ventricular Dysfunction Assessed by Layer-Specific Strain Analysis in Patients With Repaired Tetralogy of Fallot. Circ J 2017; 81:846-854. [DOI: 10.1253/circj.cj-16-1162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mariko Yamada
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | - Maki Kobayashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | - Kana Yazaki
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | - Hirobumi Takayasu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | - Katsumi Akimoto
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | - Masahiko Kishiro
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | - Akio Inage
- Department of Pediatric Cardiology, Sakakibara Heart Institute
| | | | - In-Sam Park
- Department of Pediatric Cardiology, Tokyo Women’s Medical University
| | - Keisuke Nakanishi
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine
| | - Shiori Kawasaki
- Department of Cardiovascular Surgery, Juntendo University Faculty of Medicine
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
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Lee N, Taylor MD, Banerjee RK. Right ventricle-pulmonary circulation dysfunction: a review of energy-based approach. Biomed Eng Online 2015; 14 Suppl 1:S8. [PMID: 25602641 PMCID: PMC4306123 DOI: 10.1186/1475-925x-14-s1-s8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Patients with repaired or palliated right heart congenital heart disease (CHD) are often left with residual lesions that progress and can result in significant morbidity. However, right ventricular-pulmonary arterial evaluation and the timing of reintvervention is still subjective. Currently, it relies on symptomology, or RV imaging-based metrics from echocardiography or MR derived parameters including right ventricular (RV) ejection fraction (EF), end-systolic pressure (ESP), and end-diastolic volume (EDV). However, the RV is coupled to the pulmonary vasculature, and they are not typically evaluated together. For example, the dysfunctional right ventricular-pulmonary circulation (RV-PC) adversely affects the RV myocardial performance resulting in decreased efficiency. Therefore, comprehensive hemodynamic assessment should incorporate changes in RV-PC and energy efficiency for CHD patients. The ventricular pressure-volume relationship (PVR) and other energy-based endpoints derived from PVR, such as stroke work (SW) and ventricular elastance (Ees), can provide a measure of RV performance. However, a detailed explanation of the relationship between RV performance and pulmonary arterial hemodynamics is lacking. More importantly, PVR is impractical for routine longitudinal evaluation in a clinical setting, because it requires invasive catheterization. As an alternative, analytical methods and computational fluid dynamics (CFD) have been used to compute energy endpoints, such as power loss or energy dissipation, in abnormal physiologies. In this review, we review the causes of RV-PA failure and the limitation of current clinical parameters to quantify RV-PC dysfunction. Then, we describe the advantage of currently available energy-based endpoints and emerging energy endpoints, such as energy loss in the Pas or kinetic energy, obtained from a new non-invasive imaging technique, i.e. 4D phase contrast MRI.
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A look at recent improvements in the durability of tissue valves. Gen Thorac Cardiovasc Surg 2013; 61:182-90. [DOI: 10.1007/s11748-013-0202-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Indexed: 10/27/2022]
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Jang W, Kim YJ, Choi K, Lim HG, Kim WH, Lee JR. Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair. Eur J Cardiothorac Surg 2012; 42:e1-8. [DOI: 10.1093/ejcts/ezs219] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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The cause of B-type natriuretic peptide elevation and the dose-dependent effect of angiotensin-converting enzyme inhibitor on patients late after tetralogy of Fallot repair. Pediatr Cardiol 2012; 33:264-71. [PMID: 22271387 DOI: 10.1007/s00246-011-0135-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 09/14/2011] [Indexed: 11/27/2022]
Abstract
Patients after surgical repair of tetralogy of Fallot (TOF) may experience various complications that result in neurohormonal activation, including plasma B-type natriuretic peptide (BNP) elevation. Right ventricular (RV) dilation is a frequent complication, and few treatments are available. This study aimed to identify the factor or factors leading to BNP elevation and to clarify the effects of angiotensin-converting enzyme inhibitor (ACE-I) on changes in BNP levels in patients with repaired TOF. Plasma BNP levels and hemodynamic data derived from cardiac catheterization were analyzed. In addition, longitudinal BNP levels and ACE-I dosages were analyzed for patients administered ACE-I. For 31 patients with repaired TOF, who mainly had RV dilation, log BNP levels were significantly correlated with the RV end-diastolic volume index (P = 0.02) as well as ventricular volume and pressure (P < 0.01). For 11 patients medicated with ACE-I, BNP levels were significantly lower at the time of maximal ACE-I dosage than at the time of minimal dosage (P < 0.01). Furthermore, BNP levels decreased as the ACE-I dosage per body weight increased (P < 0.01). In conclusion, elevation of BNP in patients after TOF repair could reflect volume and pressure load in the RV end-diastolic phase, and ACE-I may reduce BNP levels in a dose-dependent manner.
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Comparison of stroke work between repaired tetralogy of Fallot and normal right ventricular physiologies. Heart Vessels 2011; 28:76-85. [DOI: 10.1007/s00380-011-0212-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 11/18/2011] [Indexed: 10/14/2022]
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Cheung YF, Wong SJ, Liang XC, Cheung EWY. Torsional mechanics of the left ventricle in patients after surgical repair of tetralogy of Fallot. Circ J 2011; 75:1735-41. [PMID: 21566339 DOI: 10.1253/circj.cj-10-1253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to test the hypothesis that alteration of left ventricular (LV) torsional mechanics occurs in patients after repair of tetralogy of Fallot (TOF) and is associated with right ventricular (RV) volume overload and changes in LV configuration. METHODS AND RESULTS Fifty-five TOF patients aged 19.0 ± 8.1 years and 27 age-matched healthy controls were studied. The LV and RV volumes were measured using 3-dimensional echocardiography while LV geometry was quantified by the diastolic eccentricity index (EI). The LV peak systolic torsion and systolic twisting and diastolic untwisting velocities were determined by speckle tracking. Compared with controls, patients had significantly greater RV end-systolic (P < 0.001) and diastolic (P < 0.001) volumes and LV diastolic EI (P < 0.001). In contrast, LV peak apical rotation (P < 0.001), systolic torsion (P = 0.004), systolic twisting velocity (P = 0.001), and diastolic untwisting velocity (P = 0.001) were lower in patients than in controls. For the whole cohort, RV EDV and LV diastolic EI correlated negatively with peak systolic torsion, systolic twisting velocity, and diastolic untwisting velocity (all P ≤ 0.001). Systolic torsion correlated strongly with diastolic untwisting velocity (r = 0.72, P < 0.001), while systolic twisting velocity correlated with LV ejection fraction (r = 0.3, P = 0.005). CONCLUSIONS LV torsional mechanics is impaired and is negatively related to RV volume overload and LV eccentricity in patients after TOF repair.
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Affiliation(s)
- Yiu-Fai Cheung
- Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Smith J, Goetze JP, Søndergaard L, Kjaergaard J, Iversen KK, Vejlstrup NG, Hassager C, Andersen CB. Myocardial hypertrophy after pulmonary regurgitation and valve implantation in pigs. Int J Cardiol 2011; 159:29-33. [PMID: 21411159 DOI: 10.1016/j.ijcard.2011.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 02/06/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients may suffer from right ventricular (RV) failure and malignant cardiac arrhythmias after late pulmonary valve replacement correcting pulmonary regurgitation (PR). But the underlying mechanisms of the refractory arrhythmias are not well understood. METHODS The aim of present study was to characterize the RV myocardium after percutaneous pulmonary valve implantation (PPVI) in a porcine model after severe PR for 3months. RV histology was evaluated with morphometric methods and RV function was assessed with electrophysiology, echocardiography, and biochemical measures: The results were compared with age-matched sham-operated animals. RESULTS At euthanasia, RV weight was increased compared to sham-animals, median 127 g (115-137) vs. 71 g (69.5-76.5), p=0.0007. RV myocyte diameters corrected for individual variation with the RV/LV ratio were enlarged, 1.06 (1.02-1.13) vs. 0.84 (0.80-0.91), p=0.0006. There were no excess collagen tissue (RV/LV ratio), p=0.77. Electrophysiological stimulation resulted in RV arrhythmia in 67% of the animals compared to 25% in the sham-operated animals, but this difference was not statistically significant, p=0.28. Echocardiography revealed geometrical dilation in end-systolic RV area, mean ± SD, 11.8 ± 4.9 cm(2) vs. 6.0 ± 3.5 cm(2), p=0.05, and end-diastolic area, 23.3 ± 10.4 cm(2) vs. 12.7 ± 2.5 cm(2), p=0.08. RV anterior free wall thickness was not increased, 0.7 ± 0.2 cm vs. 0.7 ± 0.1 cm, p=0.66. Echocardiographic functional parameters and plasma natriuretic peptides were unchanged. CONCLUSIONS The RV does not completely recover after three months of PR with persistent myocardial hypertrophy one month after PPVI. Future studies should address whether RV chamber and cellular hypertrophy, without fibrosis or interventional scar tissue, may be substrate for arrhythmia.
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Affiliation(s)
- Julie Smith
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Current World Literature. Curr Opin Cardiol 2011; 26:71-8. [DOI: 10.1097/hco.0b013e32834294db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Muralidhar Padala
- Joseph B. Whitehead Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine
| | - William Brent Keeling
- Joseph B. Whitehead Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine
| | - Robert A. Guyton
- Joseph B. Whitehead Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine
| | - Vinod H. Thourani
- Joseph B. Whitehead Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine
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