Key result
Late pulmonary regurgitation fraction >15% post-valvuloplasty is linked to ~11-point lower predicted exercise capacity.
Why the study?
Balloon pulmonary valvuloplasty relieves pulmonary stenosis but can cause late pulmonary regurgitation, and the long-term sequelae of isolated pulmonary regurgitation on ventricular volume, function, and exercise tolerance were not well understood.
Does chronic isolated pulmonary regurgitation following percutaneous balloon pulmonary valvuloplasty reduce exercise capacity (percent predicted peak Vo2) and impair right ventricular volumes and function in patients with congenital valvar pulmonary stenosis?
Cohort (n=41)
No
Does chronic isolated pulmonary regurgitation following percutaneous balloon pulmonary valvuloplasty reduce exercise capacity (percent predicted peak Vo2) and impair right ventricular volumes and function in patients with congenital valvar pulmonary stenosis?
Answers are grounded in this paper and cite their sources.
Long-term mild pulmonary regurgitation and right ventricular dilation are common after percutaneous balloon valvuloplasty for valvar pulmonary stenosis (especially with younger age at intervention and balloon:annulus ratio ≥1.4), and a pulmonary regurgitation fraction >15% is associated with impaired exercise cardiopulmonary capacity.
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 ≥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 (Vo2) (% predicted) was below average (92 ± 17%, p = 0.006). Patients with PR fraction >15% had significantly lower peak Vo2 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 Vo2, suggesting that isolated PR and consequent RV dilation are related to impaired exercise cardiopulmonary function.
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Harrild et al. (2010) conducted a cohort in Congenital valvar pulmonary stenosis post-balloon valvuloplasty (n=41). Pulmonary regurgitation fraction >15% following balloon pulmonary valvuloplasty vs. Pulmonary regurgitation fraction <=15% following balloon pulmonary valvuloplasty was evaluated on Percent predicted peak oxygen consumption (peak VO2) (p=0.03). Pulmonary regurgitation fraction >15% late after balloon valvuloplasty was associated with lower percent predicted exercise capacity compared to PR fraction <=15%.
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