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Pulmonary Valve Replacement Surgery Leads to Near Normalisation of Right Ventricular Dimensions in Young Adults with Repaired Tetralogy of Fallot
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Abstracts
Heart, Lung and Circulation 2011;20S:S156–S251
ABSTRACTS
582 QRS Duration and Long Term Benefit of Cardiac Resynchronisation Therapy—A Single Paediatric Centre Experience A. Rotstein 1 , A. Davis 1,2 , S. Kamberi 1 , D. Scicluna 1,∗ , J. Koleff 1 , M. Cheung 1,2 , R. Weintaub 1,2 , A. Pflaumer 1 1 The
Royal Children’s Hospital, Melbourne, Australia Children’s Research Institute, Australia
2 Murdoch
Conclusions: The rheumatic mitral valve loses its saddle shape resulting in increased 2D leaflet area. This is likely to be primary mechanism of regurgitation in RMVD given that annular diameter is unchanged. doi:10.1016/j.hlc.2011.05.584 581 Pulmonary Valve Replacement Surgery Leads to Near Normalisation of Right Ventricular Dimensions in Young Adults with Repaired Tetralogy of Fallot S. O’Meagher 1,2,∗ , D. Celermajer 1,2 , R. Puranik 1,2 1 University
of Sydney, Australia
2 Department of Cardiology, Royal Prince Alfred Hospital, Syd-
ney, Australia Background and aims: Pulmonary regurgitation (PR) following Tetralogy of Fallot (TOF) repair causes progressive dilatation and eventually dysfunction of the right ventricle (RV); pulmonary valve replacement (PVR) is thus often undertaken. We studied the consequences of PVR on cardiac structure, function and exercise capacity. Methods: Eight adult patients with repaired TOF (mean age at repair 2.2 ± 1.2 years; age at study 29.1 ± 8.6 years) had cardiac MRI (1.5 T) and cardiopulmonary exercise test before and 14.4 ± 2.7 (range 11.8–19.3) months after PVR, undertaken according to current guidelines (when right ventricular end diastolic volume index exceeds 150 ml/m2 ). Results: At follow up, we observed marked improvements in RV volumes; reduced end diastolic (200 ± 43 mL/m2 vs 120 ± 26 mL/m2 , p = 0.0005) and end systolic volume indices (111 ± 44 mL/m2 vs 67 ± 27 mL/m2 , p = 0.03), within the normal range (55–105 mL/m2 ) in three of eight patients. There were no significant difference in left ventricular (LV) parameters (LV stroke volume 93 ± 5 mL vs 101 ± 8 mL, p = 0.42; LV ejection fraction 58 ± 3% vs 59 ± 2%, p = 0.93). Exercise capacity had been near normal pre-PVR; post-procedure measurements were similar (% predicted maximal workload: 96 ± 6% vs 94 ± 5%, p = 0.89 and; % predicted oxygen uptake: 94 ± 3% vs 92 ± 3%, p = 0.67). Conclusions: RV dimensions and pulmonary regurgitation were reduced to near-normal levels one year after PVR, in subjects with pre-operative severe RV dilatation. doi:10.1016/j.hlc.2011.05.585
Background: Cardiac resynchronisation therapy (CRT) is an accepted treatment for adult patients with systemic ventricular dysfunction and conduction delay of ≥120 ms. Failure of CRT based on QRS duration (QRSD) remains high. The predictive value of pre CRT QRSD on long-term outcome of CRT in pediatric patients is as yet unknown. Methods: A retrospective review measuring pre CRT QRSD and assessing long term response rate and outcome as demonstrated by change of the systemic ventricular ejection fraction (EF). Results: Twenty-five patients underwent CRT since 2003. Six patients had CRT as preemptive therapy and were excluded. Nineteen patients had ventricular dysfunction prior to CRT despite optimal medical therapy. Indication for CRT included heart failure in the setting of long standing ventricular pacing, heart failure with prolonged QRSD and/or proven dyssynchrony demonstrated by Tissue Doppler (TD) echocardiography. Long-term follow-up was available for 15/19 patients. The median age at time of CRT was 9.2 years (0.3–17.1 years). Mean duration of follow-up was 4.4 years (±1.5 years). The mean pre-CRT QRS duration was 132.8 ± 28.5 ms. Systemic ventricular EF increased from a mean of 32.5 ± 10.7% to 48.2 ± 10.7% (p < 0.007) with a mean increase of 15.8 ± 12.9. QRSD >114 ms was a predictor of improvement in EF with a mean increase of ventricular EF of 20.7 ± 9.4% compared to −0.7 ± 8.5% for those with QRSD ≤114 ms (p < 0.005). Of the three patients with QRSD <114 ms only one patient with QRSD of 90 ms and dyssynchrony on TD echocardiography improved with CRT. Two patients died at six weeks and four months post CRT and no patient has undergone heart transplantation. Overall success rate defined by long term survival and more than 5% improvement in ventricular EF was 73.3% (11/15). Conclusions: CRT in selected children with systemic ventricular dysfunction and QRSD ≥114 ms may be associated with long term benefit and improvement in ventricular systolic function. doi:10.1016/j.hlc.2011.05.586
Abstracts
Heart, Lung and Circulation 2011;20S:S156–S251
ABSTRACTS
582 QRS Duration and Long Term Benefit of Cardiac Resynchronisation Therapy—A Single Paediatric Centre Experience A. Rotstein 1 , A. Davis 1,2 , S. Kamberi 1 , D. Scicluna 1,∗ , J. Koleff 1 , M. Cheung 1,2 , R. Weintaub 1,2 , A. Pflaumer 1 1 The
Royal Children’s Hospital, Melbourne, Australia Children’s Research Institute, Australia
2 Murdoch
Conclusions: The rheumatic mitral valve loses its saddle shape resulting in increased 2D leaflet area. This is likely to be primary mechanism of regurgitation in RMVD given that annular diameter is unchanged. doi:10.1016/j.hlc.2011.05.584 581 Pulmonary Valve Replacement Surgery Leads to Near Normalisation of Right Ventricular Dimensions in Young Adults with Repaired Tetralogy of Fallot S. O’Meagher 1,2,∗ , D. Celermajer 1,2 , R. Puranik 1,2 1 University
of Sydney, Australia
2 Department of Cardiology, Royal Prince Alfred Hospital, Syd-
ney, Australia Background and aims: Pulmonary regurgitation (PR) following Tetralogy of Fallot (TOF) repair causes progressive dilatation and eventually dysfunction of the right ventricle (RV); pulmonary valve replacement (PVR) is thus often undertaken. We studied the consequences of PVR on cardiac structure, function and exercise capacity. Methods: Eight adult patients with repaired TOF (mean age at repair 2.2 ± 1.2 years; age at study 29.1 ± 8.6 years) had cardiac MRI (1.5 T) and cardiopulmonary exercise test before and 14.4 ± 2.7 (range 11.8–19.3) months after PVR, undertaken according to current guidelines (when right ventricular end diastolic volume index exceeds 150 ml/m2 ). Results: At follow up, we observed marked improvements in RV volumes; reduced end diastolic (200 ± 43 mL/m2 vs 120 ± 26 mL/m2 , p = 0.0005) and end systolic volume indices (111 ± 44 mL/m2 vs 67 ± 27 mL/m2 , p = 0.03), within the normal range (55–105 mL/m2 ) in three of eight patients. There were no significant difference in left ventricular (LV) parameters (LV stroke volume 93 ± 5 mL vs 101 ± 8 mL, p = 0.42; LV ejection fraction 58 ± 3% vs 59 ± 2%, p = 0.93). Exercise capacity had been near normal pre-PVR; post-procedure measurements were similar (% predicted maximal workload: 96 ± 6% vs 94 ± 5%, p = 0.89 and; % predicted oxygen uptake: 94 ± 3% vs 92 ± 3%, p = 0.67). Conclusions: RV dimensions and pulmonary regurgitation were reduced to near-normal levels one year after PVR, in subjects with pre-operative severe RV dilatation. doi:10.1016/j.hlc.2011.05.585
Background: Cardiac resynchronisation therapy (CRT) is an accepted treatment for adult patients with systemic ventricular dysfunction and conduction delay of ≥120 ms. Failure of CRT based on QRS duration (QRSD) remains high. The predictive value of pre CRT QRSD on long-term outcome of CRT in pediatric patients is as yet unknown. Methods: A retrospective review measuring pre CRT QRSD and assessing long term response rate and outcome as demonstrated by change of the systemic ventricular ejection fraction (EF). Results: Twenty-five patients underwent CRT since 2003. Six patients had CRT as preemptive therapy and were excluded. Nineteen patients had ventricular dysfunction prior to CRT despite optimal medical therapy. Indication for CRT included heart failure in the setting of long standing ventricular pacing, heart failure with prolonged QRSD and/or proven dyssynchrony demonstrated by Tissue Doppler (TD) echocardiography. Long-term follow-up was available for 15/19 patients. The median age at time of CRT was 9.2 years (0.3–17.1 years). Mean duration of follow-up was 4.4 years (±1.5 years). The mean pre-CRT QRS duration was 132.8 ± 28.5 ms. Systemic ventricular EF increased from a mean of 32.5 ± 10.7% to 48.2 ± 10.7% (p < 0.007) with a mean increase of 15.8 ± 12.9. QRSD >114 ms was a predictor of improvement in EF with a mean increase of ventricular EF of 20.7 ± 9.4% compared to −0.7 ± 8.5% for those with QRSD ≤114 ms (p < 0.005). Of the three patients with QRSD <114 ms only one patient with QRSD of 90 ms and dyssynchrony on TD echocardiography improved with CRT. Two patients died at six weeks and four months post CRT and no patient has undergone heart transplantation. Overall success rate defined by long term survival and more than 5% improvement in ventricular EF was 73.3% (11/15). Conclusions: CRT in selected children with systemic ventricular dysfunction and QRSD ≥114 ms may be associated with long term benefit and improvement in ventricular systolic function. doi:10.1016/j.hlc.2011.05.586