Division of Pediatric and Adult Congenital Cardiology, The Pediatric Heart Institute, Joe DiMaggio Children's Hospital, 1150 North 35 Avenue, Suite 490, Hollywood, FL, USA.
Cardiol Young. 2023 Oct;33(10):1840-1845. doi: 10.1017/S1047951122003286. Epub 2022 Oct 19.
Right ventricular outflow tract intervention spans transcatheter, surgical, or hybrid pulmonary valve replacement methodologies. Standardised pre-procedure workup includes cardiac MRI to identify an intended valve site (landing zone). Our institutional practice includes measurement of the right ventricular outflow tract perimeter (circumference) of this site in end-systole. Our primary aim was to compare patients by their perimeter values to the palliative interventions performed (transcatheter versus surgical/hybrid methodologies).
Retrospective review of patients undergoing pulmonary valve replacement from January 2017 to 2021. We performed perimeter measurements at the intended valve site on advanced imaging; the outcomes of interventions were outlined via descriptive and statistical analyses.
A total of 37 patients underwent pulmonary valve replacement that met study criteria - 21 transcatheter, 7 surgical, and 9 hybrid. Median age at intervention was 26 years (range 8-70). The mean end-systolic perimeter of the transcatheter cohort was 88.9 ± 8.7 mm and in the surgical/hybrid cohort measured 106.6 ± 7.5 mm. For the transcatheter cohort, the median "circularised" diameter derived from the perimeter measurement (divided by π) was 27.7 mm (range 24.3-32.4). Notably, this correlated (r = 0.93, p < 0.01) with the median diameter of the narrowest region during actual transcatheter right ventricular outflow tract balloon sizing (lateral imaging) of 27.1 mm (range 23.2-30.1).
Right ventricular outflow tract perimeter measurement to determine circularised diameter is useful in planning pulmonary valve replacement in terms of candidacy of transcatheter versus the need for a surgical/hybrid approach. The circularised diameter correlates with transcatheter right ventricular outflow tract balloon sizing.
右心室流出道干预包括经导管、外科或杂交肺动脉瓣置换方法。标准的术前检查包括心脏 MRI 以确定预期的瓣位（着陆区）。我们的机构实践包括测量该部位的右心室流出道周长（周长）在收缩末期。我们的主要目的是通过周长值比较患者，以了解姑息性干预措施（经导管与外科/杂交方法）。
回顾性分析 2017 年 1 月至 2021 年期间接受肺动脉瓣置换术的患者。我们在先进的影像学上对预期的瓣位进行周长测量；通过描述性和统计分析概述干预的结果。
共有 37 名符合研究标准的患者接受了肺动脉瓣置换术 - 21 名经导管、7 名外科和 9 名杂交。介入时的中位年龄为 26 岁（范围 8-70 岁）。经导管组的平均收缩末期周长为 88.9 ± 8.7mm，外科/杂交组为 106.6 ± 7.5mm。对于经导管组，从周长测量得出的“圆形化”直径（除以π）的中位数为 27.7mm（范围 24.3-32.4）。值得注意的是，这与实际经导管右心室流出道球囊测量时最窄区域的直径（侧位成像）的中位数 27.1mm（范围 23.2-30.1）相关（r = 0.93，p < 0.01）。
确定圆形化直径的右心室流出道周长测量在经导管与外科/杂交方法的候选性方面对肺动脉瓣置换术的规划有用。圆形化直径与经导管右心室流出道球囊测量相关。
