Key result
Accounting for pressure recovery on Doppler echo reclassifies ~61% of severe homograft stenosis cases to moderate.
Why the study?
Pressure recovery increases functional aortic valve orifice area, but little is known about the relevance of pressure recovery in the pulmonary artery.
Does considering pressure recovery in Doppler echocardiography improve the assessment of pulmonary homograft stenosis severity in patients after Ross surgery?
Observational (n=92)
Does considering pressure recovery in Doppler echocardiography improve the assessment of pulmonary homograft stenosis severity in patients after Ross surgery?
Neglecting pressure recovery in Doppler echocardiography overestimates pulmonary homograft stenosis severity and right ventricular load, potentially leading to premature surgery.
Answers are grounded in this paper and cite their sources.
May reclassify severe homograft stenosis as moderate after Ross surgery; leaves open prospective validation before changing practice.
Relevant pressure recovery (PR) has been shown to increase functional stenotic aortic valve orifice area and reduce left ventricular load. However, little is known about the relevance of PR in the pulmonary artery. The study examined the impact of PR using 2D‐echocardiography in the pulmonary artery distal to the degenerated homograft in patients after Ross surgery. Ninety‐two patients with pulmonary homograft were investigated by Doppler echocardiography (mean time interval after surgery 31 ± 26 months). PR was measured as a function of pulmonary artery diameter determined by computed tomography angiography. Homograft orifice area, valve resistance, and transvalvular stroke work were calculated with and without considering PR. PR decreased as the pulmonary artery diameter increased ( r = −0.69, p < 0.001). Mean PR was 41.5 ± 7.1% of the Doppler‐derived pressure gradient ( P max ), which resulted in a markedly increased homograft orifice area (energy loss coefficient index [ELCOI] vs. effective orifice area index [EOAI], 1.3 ± 0.4 cm 2 /m 2 vs. 0.9 ± 0.4 cm 2 /m 2 , p < 0.001). PR significantly reduced homograft resistance and transvalvular stroke work (822 ± 433 vs. 349 ± 220 mmHg × ml, p < 0.0001). When PR was considered, the correlations of the parameters used were significantly better, and 11 of 18 patients (61%) in the group with severe homograft stenosis (EOAI <0.6 cm 2 /m 2 ) could be reclassified as moderate stenosis. Our results showed that the Doppler measurements overestimated the degree of homograft stenosis and thus the right ventricular load, when PR was neglected in the pulmonary artery. Therefore, Doppler measurements that ignore PR can misclassify homograft stenosis and may lead to premature surgery.
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Reil et al. (2022) conducted an observational in Pulmonary homograft stenosis after Ross surgery (n=92). Doppler echocardiography accounting for pressure recovery (ELCOI) vs. Doppler echocardiography without accounting for pressure recovery (EOAI) was evaluated on Homograft orifice area index (cm2/m2) (p=<0.001). Accounting for pressure recovery in Doppler echocardiography increased the calculated homograft orifice area (1.3 vs 0.9 cm2/m2, p<0.001), reclassifying 61% of severe stenosis cases to moderate.
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