Key result
Pulsta PPVI leaves residual pulmonary regurgitation in ~41% of patients.
Why the study?
Pulmonary valve replacement recommendations rely on CMR-derived RV volume thresholds from repaired tetralogy of Fallot, whereas self-expanding PPVI patients often have mixed pulmonary regurgitation and stenosis with heterogeneous RVOT anatomy, leaving CMR predictors of post-PPVI residual regurgitation and ventricular remodeling unclear.
What pre-procedural cardiovascular magnetic resonance parameters predict residual pulmonary regurgitation, right ventricular enlargement, and biventricular imbalance in patients undergoing Pulsta percutaneous pulmonary valve implantation?
Observational (n=98)
What pre-procedural cardiovascular magnetic resonance parameters predict residual pulmonary regurgitation, right ventricular enlargement, and biventricular imbalance in patients undergoing Pulsta percutaneous pulmonary valve implantation?
After Pulsta percutaneous pulmonary valve implantation, pre-procedural anatomical morphology, RVEDVi z-score, and RV/LV volume ratio predict residual regurgitation and biventricular remodeling, offering complementary metrics to improve patient selection.
Answers are grounded in this paper and cite their sources.
Residual PR warrants vigilant post-procedural surveillance in children; leaves open optimal reintervention thresholds and long-term outcomes.
Current recommendations for pulmonary valve replacement are based primarily on cardiovascular magnetic resonance (CMR)-derived right ventricular (RV) volume thresholds established in repaired tetralogy of Fallot. However, patients undergoing self-expanding percutaneous pulmonary valve implantation (PPVI) often have mixed pulmonary regurgitation (PR) and pulmonary stenosis with heterogeneous right ventricular outflow tract (RVOT) anatomy. We investigated CMR predictors of residual PR, residual RV enlargement (RVE), and residual biventricular imbalance (BVI) after Pulsta PPVI. We retrospectively analyzed 98 patients with paired pre- and post-procedural CMR. Residual PR was defined as post-procedural PR fraction (PRF) ≥10%, residual RVE as RV end-diastolic volume index (RVEDVi) ≥130 mL/m2, and residual BVI as an RV/LV end-diastolic volume ratio ≥1.5. Multivariable regression and restricted cubic spline analyses identified predictors of post-procedural remodeling. Residual PR occurred in 40.8% of patients, residual RVE in 38.8%, and residual BVI in 40.8%. Pyramidal/convex main pulmonary artery morphology and higher baseline PRF independently predicted residual PR, whereas reverse pyramidal/concave morphology was associated with lower residual RVE risk. Higher pre-procedural RV/LV ratio independently predicted residual BVI. RVEDVi z-score remained independently associated with RVEDVi reduction after adjustment for baseline RVEDVi. Although RV volumes decreased substantially after PPVI, LV remodeling varied considerably, and both RVEDVi and LVEDVi change independently contributed to recovery of ventricular balance. After Pulsta PPVI, anatomical factors influence residual PR and RV remodeling. RVEDVi z-score and RV/LV ratio provide complementary information that may improve patient selection.
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Baek et al. (2026) conducted an observational in Pulmonary regurgitation and/or pulmonary stenosis undergoing Pulsta percutaneous pulmonary valve implantation (n=98). Pulsta percutaneous pulmonary valve implantation and pre-procedural CMR predictors was evaluated on Residual pulmonary regurgitation (PRF >=10%), residual RV enlargement (RVEDVi >=130 mL/m2), and residual biventricular imbalance (RV/LV end-diastolic volume ratio >=1.5). Pulsta percutaneous pulmonary valve implantation resulted in residual pulmonary regurgitation in 40.8%, residual RV enlargement in 38.8%, and residual biventricular imbalance in 40.8% of patients.
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