Percutaneous pulmonary valve implantation significantly improved early LV diastolic filling from 17.5 to 30.4 mL/m2 (P<0.001) by reducing interventricular mechanical delay.
Observational (n=20)
Does percutaneous pulmonary valve implantation improve left ventricular filling properties and exercise capacity in patients with congenital heart disease and right ventricle to pulmonary artery conduit obstruction?
Relief of right ventricle to pulmonary artery conduit obstruction via percutaneous pulmonary valve implantation improves early left ventricular filling properties and exercise capacity by reducing interventricular mechanical delay and improving septal motion.
Absolute Event Rate: 30.4% vs 17.5%
p-value: p=<0.001
AIMS: To investigate the impact of relief of right ventricle (RV) to pulmonary artery (PA) conduit obstruction on septal motion and ventricular interaction and its functional implications for left ventricular (LV) filling properties. METHODS AND RESULTS: In 20 consecutive patients with congenital heart disease and RV to PA conduit obstruction, the following were prospectively assessed before and after percutaneous pulmonary valve implantation (PPVI): the septal curvature and LV volumes throughout the cardiac cycle by magnetic resonance imaging; RV to LV mechanical delay by 2D-echocardiographic strain imaging; and objective exercise capacity. Percutaneous pulmonary valve implantation led to a reduction in RV to LV mechanical delay (127.9 +/- 50.9 vs. 37.7 +/- 35.6 ms; P < 0.001) and less LV septal bowing in early LV diastole (septal curvature: -0.11 +/- 0.11 vs. 0.07 +/- 0.13 cm(-1); P < 0.001). Early LV diastolic filling (first one-third of diastole) increased significantly (17.5 +/- 9.4 to 30.4 +/- 9.4 mL/m(2); P < 0.001). The increase in early LV diastolic filling correlated with the reduction in RV to LV mechanical delay (r = -0.68; P = 0.001) and change in septal curvature (r = 0.71; P < 0.001). In addition, the improvement in peak oxygen uptake (56.0 +/- 16.0 vs. 64.1 +/- 13.7% of predicted; P < 0.001) was associated with the increase in early LV diastolic filling (r = 0.69; P = 0.001). CONCLUSION: Relief of RV to PA conduit obstruction significantly improves early LV filling properties. This is attributed to more favourable septal motion and reduction in interventricular mechanical delay.
Lurz et al. (Fri,) conducted a observational in congenital heart disease and RV to PA conduit obstruction (n=20). percutaneous pulmonary valve implantation (PPVI) vs. baseline (before PPVI) was evaluated on early LV diastolic filling (first one-third of diastole) (p=<0.001). Percutaneous pulmonary valve implantation significantly improved early LV diastolic filling from 17.5 to 30.4 mL/m2 (P<0.001) by reducing interventricular mechanical delay.