Transcatheter pulmonary valve implantation (PVI) is an emerging therapy for right
ventricular (RV) outflow dysfunction in congenital heart disease. We investigated,
for the first time in children after surgery for congenital heart disease, the short-term
effects of PVI on RV and left ventricular (LV) function using 2-dimensional speckle
tracking echocardiography and tissue Doppler imaging. We hypothesized that the short-term
RV and LV function would improve. Two-dimensional speckle tracking echocardiograms
and pulsed tissue Doppler images were obtained before and 1 to 2 days after PVI (18-mm
Melody valve). The catheter right heart hemodynamics were recorded. The strain and
strain rate of the basal lateral left ventricle, lateral right ventricle, and interventricular
septum were measured by 2-dimensional speckle tracking echo, and the pre- and postprocedure
values were compared. Of the 16 eligible patients (age 16 ± 2 years), the scans of
10 had correct image format and adequate quality. PVI was performed for volume (n
= 4) or combined pressure-volume (n = 6) loading. After PVI, the RV to pulmonary artery
pressure gradient (33 ± 22 to 12 ± 4 mm Hg, p = 0.02), pulmonary regurgitation, and
RV end-diastolic volume (3.2 ± 0.8 to 2.8 ± 0.6 cm, p = 0.02) decreased, and the septal
systolic velocities (3.5 ± 1.1 to 4.7 ± 1.1 cm/s, p = 0.04), strain (−7.6 ± 9.3% to
−15.6% ± 6.7%, p = 0.01) and strain rate (−0.3 ± 1.1 to −1.1 ± 0.5 1/s, p = 0.04)
and RV free wall strain increased (−17.4 ± 8.6% to −23.4% ± 6.2%, p = 0.03). The LV
tissue velocities, strain, and strain rate were unchanged. In conclusion, PVI leads
to RV unloading and acutely improves RV and septal function.
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Article info
Publication history
Published online: July 13, 2009
Accepted:
May 5,
2009
Received in revised form:
May 5,
2009
Received:
February 11,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
