Document Detail


Long-term pulmonary regurgitation following balloon valvuloplasty for pulmonary stenosis risk factors and relationship to exercise capacity and ventricular volume and function.
MedLine Citation:
PMID:  20202522     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to examine the prevalence and predictors of pulmonary regurgitation (PR) following balloon dilation (BD) for pulmonary stenosis (PS) and to investigate its impact on ventricular volume and function, and exercise tolerance. BACKGROUND: Balloon pulmonary valvuloplasty relieves PS but can cause late PR. The sequelae of isolated PR are not well understood. METHODS: Patients were at least 7 years of age and 5 years removed from BD, and had no other form of congenital heart disease or significant residual PS. Cardiac magnetic resonance imaging and exercise testing were performed prospectively to quantify PR fraction, ventricular volumes and function, and exercise capacity. RESULTS: Forty-one patients underwent testing a median of 13.1 years after BD. The median PR fraction was 10%; 14 patients (34%) had PR fraction >15%; 7 (17%) had PR >30%. PR fraction was associated with age at dilation (ln-transformed, R = -0.47, p = 0.002) and balloon:annulus ratio (R = 0.57, p < 0.001). The mean right ventricular (RV) end-diastolic volume z-score was 1.8 +/- 1.9; RV dilation (z-score > or =2) was present in 14/35 patients (40%). PR fraction correlated closely with indexed RV end-diastolic volume (R = 0.79, p < 0.001) and modestly with RV ejection fraction (R = 0.50, p < 0.001). Overall, peak oxygen consumption (Vo(2)) (% predicted) was below average (92 +/- 17%, p = 0.006). Patients with PR fraction >15% had significantly lower peak Vo(2) than those with less PR (85 +/- 17% vs. 96 +/- 16%, p = 0.03). CONCLUSIONS: Mild PR and RV dilation are common in the long term following BD. A PR fraction >15% is associated with lower peak Vo(2), suggesting that isolated PR and consequent RV dilation are related to impaired exercise cardiopulmonary function.
Authors:
David M Harrild; Andrew J Powell; Trang X Tran; Trang X Trang; Tal Geva; James E Lock; Jonathan Rhodes; Doff B McElhinney
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-05     Completed Date:  2010-03-29     Revised Date:  2010-04-13    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1041-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Departments of Cardiology, Children's Hospital Boston, and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA. david.harrild@cardio.chboston.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Balloon Dilatation / adverse effects*
Blood Pressure / physiology
Carbon Dioxide / blood
Cardiac Volume / physiology*
Child
Child, Preschool
Exercise Test*
Female
Follow-Up Studies
Heart Catheterization
Humans
Hypertrophy, Right Ventricular / etiology*,  physiopathology
Image Processing, Computer-Assisted
Infant
Magnetic Resonance Imaging / methods
Male
Oxygen / blood
Pulmonary Valve Insufficiency / etiology*,  physiopathology
Pulmonary Valve Stenosis / congenital,  therapy*
Risk Factors
Stroke Volume / physiology*
Young Adult
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2010 Mar 9;55(10):1048-9   [PMID:  20202523 ]
Erratum In:
J Am Coll Cardiol. 2010 Apr 20;55(16):1767
Note: Trang, Trang X [corrected to Tran, Trang X]

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