Moiduddin Nasser, Texter Karen M, Cheatham John P, Chisolm Joanne L, Kovalchin John P, Nicholson Lisa, Belfrage Katharine M, Janevski Ilija, Cua Clifford L
The Heart Center at Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
Congenit Heart Dis. 2012 Jul-Aug;7(4):361-71. doi: 10.1111/j.1747-0803.2012.00680.x. Epub 2012 Jun 4.
Percutaneous pulmonary valve implantation (PPVI) is an emerging therapy for pulmonary valve dysfunction. Minimal data on the midterm effects of PPVI on ventricular function exist. We describe the effects of PPVI on right and left ventricular (RV, LV) function with speckle tracking echocardiography.
Patients who met the inclusion criteria of the Food and Drug Administration Phase 1 Feasibility Clinical Trial PPVI were identified. Patients were studied with echocardiograms at baseline, post-PPVI (day of discharge), 3 months, and at 6 months. Patients were studied by cardiac magnetic resonance at baseline and at 6 months. Longitudinal strain was measured at the basal, mid, and apical portions of the RV, interventricular septum (IVS), and LV. Global RV and LV strain and strain rates were recorded. Paired t-tests were used for analysis.
Ten patients were analyzed: nine patients were a variant of tetralogy of Fallot and one patient had complex LV outflow obstruction requiring a Ross and RV-pulmonary atresia conduit. Mean age was 24.4 ± 7.6 years. Indication for PPVI was pulmonary regurgitation in six patients, stenosis in two patients, and stenosis/regurgitation in two patients. After PPVI, both RV systolic pressure and RV to pulmonary artery pressure gradient significantly decreased. Cardiac magnetic resonance RV end-diastolic volume significantly decreased. IVS-mid, IVS-apical, and LV-global strain significantly increased and RV-basal decreased immediately after PPVI. Global RV a' strain rate significantly increased immediately after PPVI. However, RV, IVS, and LV strain/strain rate values between baseline and the 6 month echocardiographic study were either similar or significantly decreased.
Despite improvement in RV hemodynamics, there was a decrease or no improvement in RV and LV function as measured by strain echocardiographic values at midterm follow-up. Larger studies with longer follow-up are needed to determine if these results remain consistent.
经皮肺动脉瓣植入术（PPVI）是治疗肺动脉瓣功能障碍的一种新兴疗法。关于PPVI对心室功能中期影响的数据极少。我们用斑点追踪超声心动图描述PPVI对右心室和左心室（RV，LV）功能的影响。
确定符合美国食品药品监督管理局1期可行性临床试验PPVI纳入标准的患者。在基线、PPVI后（出院日）、3个月和6个月时对患者进行超声心动图检查。在基线和6个月时对患者进行心脏磁共振检查。测量RV、室间隔（IVS）和LV基底、中间和心尖部分的纵向应变。记录整体RV和LV应变及应变率。采用配对t检验进行分析。
分析了10例患者：9例为法洛四联症变异型，1例患有复杂的LV流出道梗阻，需要进行Ross手术及RV-肺动脉闭锁导管植入术。平均年龄为24.4±7.6岁。PPVI的适应证为6例患者存在肺动脉反流，2例患者存在狭窄，2例患者存在狭窄/反流。PPVI后，RV收缩压和RV与肺动脉之间的压力梯度均显著降低。心脏磁共振显示RV舒张末期容积显著减小。PPVI后立即出现IVS中间、IVS心尖和LV整体应变显著增加，RV基底应变减小。PPVI后立即出现整体RV a'应变率显著增加。然而，基线与6个月超声心动图检查之间的RV、IVS和LV应变/应变率值要么相似，要么显著降低。
尽管RV血流动力学有所改善，但在中期随访时，通过应变超声心动图值测量的RV和LV功能有所下降或无改善。需要进行更大规模、更长随访时间的研究来确定这些结果是否仍然一致。
