Immediate clinical and haemodynamic benefits of restoration of pulmonary valvar competence in patients with pulmonary hypertension
- 1 Cardiac Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK
- 2 The Heart Hospital NHS Trust, London, UK
- Ingram Schulze-Neick, Cardiac Unit, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; neicki{at}gosh.nhs.uk
- Accepted 14 October 2008
Abstract
Objective: To analyse the potential benefit of restoration of pulmonary valvar competence in patients with severe pulmonary regurgitation (PR) and pulmonary hypertension (PH) associated with congenital heart disease.
Design: Retrospective study.
Setting: Tertiary paediatric and adult congenital heart cardiac centre.
Interventions: Percutaneous pulmonary valve implantation (PPVI).
Patients: All patients who underwent PPVI for treatment of PR in the presence of PH (mean PAP >25 mm Hg).
Results: Seven patients with severe PH as a result of congenital heart disease and severe PR underwent PPVI. The valve implantation procedure was feasible and uncomplicated in all seven cases, successfully abolishing PR. There was a significant increase in diastolic (15.4 (7.3) to 34.0 (8.5) mm Hg; p = 0.007) and mean (29.7 (8.1) to 41.3 (12.9) mm Hg; p = 0.034) pulmonary artery pressures, and an improvement in NYHA functional class (from median IV to median III; p<0.008). Peripheral oxygen saturations rose from 85.9% (11.0%) to 91.7% (8.3%) (p = 0.036). Right ventricular (RV) volumes decreased (from 157.0 (44.7) to 140.3 (53.3) ml/m2), while effective RV stroke volume increased (from 23.4 (9.3) to 41.0 (11.6) ml/m2). During a median follow-up of 20.3 months (range 1.3–47.5), valvar competence was well maintained despite near systemic pulmonary pressures. None of the valved stents were explanted during follow-up.
Conclusion: Trans-catheter treatment of PR in patients with PH is well tolerated and leads to clinical and haemodynamic improvement, most probably caused by a combination of increased pulmonary perfusion pressures and RV efficiency.
Footnotes
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Funding: PL is funded by the European Union (Health-e-Child Initiative, grant no 027749); LC was funded by a BHF Junior Fellowship; AMT is funded by the Higher Education Funding Council for England (HEFCE) and by the British Heart Foundation (grant no CI/05/010); PB received a BHF programme grant (RG/03/006).
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Competing interests: PL and LC have received honoraria from Medtronic. AMT is consultant to Medtronic and has received honoraria. PB is consultant to Medtronic and NuMed and has received honoraria and royalties for the device described. The remaining authors report no conflicts.
