Sirico Domenico, Spigariol Giulia, Mahmoud Heba Talat, Basso Alessia, Cuppini Elena, Avesani Martina, Sabatino Jolanda, Castaldi Biagio, Di Salvo Giovanni
Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, 35128 Padua, Italy.
Experimental Cardiology, Paediatric Research Institute (IRP), Città della Speranza, University of Padova, 35122 Padua, Italy.
J Clin Med. 2023 Jun 28;12(13):4344. doi: 10.3390/jcm12134344.
Pulmonary valve stenosis determines multiple effects on the right ventricular dimension and function. Percutaneous balloon valvuloplasty is the treatment of choice in severe pulmonary valve stenosis in patients of all ages. However, little is known regarding right ventricular function immediate changes after percutaneous balloon dilation. Pediatric patients with isolated pulmonary valve stenosis represent a pure clinical model of chronic RV pressure overload not affected by other confounders or comorbidities.
This study seeks to explore right ventricle (RV) mechanics in pediatric patients early after percutaneous balloon pulmonary valvuloplasty (BPV) for valvar pulmonary stenosis (PS).
Forty-three pediatric patients (19 males), mean age 3.2 ± 4.9 years old, with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent standard transthoracic echocardiography (TTE), and speckle-tracking echocardiography (STE) with an analysis of right ventricle free-wall longitudinal strain (RVFWLS) one day before and one day after the procedure. For each patient, we collected invasive parameters during the interventional procedure before and after BPV.
After the procedure, there was an immediate significant reduction in both peak-to-peak transpulmonary gradient (peak-to-peak PG) and ratio between the right ventricle and aortic systolic pressure (RV/AoP) with a drop of ∆29.3 ± 14.67 mmHg and ∆0.43 ± 0.03, respectively. Post-procedural echocardiography showed peak and mean transvalvar pressure gradient drop (∆50 ± 32.23 and ∆31 ± 17.97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, affecting 29% of our patients post-BPV ( = 0.007). The analysis of right ventricular mechanics showed a significant improvement of fractional area change (FAC) immediately after BPV (40.11% vs. 44.42%, = 0.01). On the other hand, right ventricular longitudinal systolic function parameters, TAPSE and global RVFWLS, did not improve significantly after intervention. The segmental analysis of the RVFWLS showed a significant regional increase in the myocardial deformation of the apical segments.
Percutaneous BPV represents an efficient and safe procedure to relieve severe pulmonary valve stenosis. The analysis of the right ventricular function on echocardiography demonstrated an immediate global systolic function improvement, while longitudinal systolic function was persistently impaired 24 h after intervention, possibly due to the necessity of a longer recovery time.
肺动脉瓣狭窄对右心室大小和功能有多种影响。经皮球囊瓣膜成形术是各年龄段严重肺动脉瓣狭窄患者的首选治疗方法。然而，对于经皮球囊扩张术后右心室功能的即刻变化知之甚少。孤立性肺动脉瓣狭窄的儿科患者代表了一种单纯的慢性右心室压力超负荷临床模型，不受其他混杂因素或合并症的影响。
本研究旨在探讨小儿肺动脉瓣狭窄患者经皮球囊肺动脉瓣成形术（BPV）后早期右心室（RV）力学变化。
招募了43例小儿患者（19例男性），平均年龄3.2±4.9岁，患有严重肺动脉瓣狭窄且有经皮球囊瓣膜成形术指征。所有患者在手术前一天和手术后一天均接受标准经胸超声心动图（TTE）检查，并采用斑点追踪超声心动图（STE）分析右心室游离壁纵向应变（RVFWLS）。对于每位患者，我们在BPV前后的介入手术过程中收集了有创参数。
术后，跨肺动脉峰值压差（peak-to-peak PG）和右心室与主动脉收缩压之比（RV/AoP）立即显著降低，分别下降了∆29.3±14.67 mmHg和∆0.43±0.03。术后超声心动图显示瓣膜峰值和平均压力阶差下降（分别为∆50±32.23和∆31±17.97）。术前8%的患者存在轻度肺动脉瓣反流，BPV术后这一比例为29%（P = 0.007）。右心室力学分析显示，BPV术后即刻面积变化分数（FAC）显著改善（40.11%对44.42%，P = 0.01）。另一方面，右心室纵向收缩功能参数，即三尖瓣环平面收缩期位移（TAPSE）和整体RVFWLS，在干预后未显著改善。RVFWLS的节段分析显示，心尖节段心肌变形有显著的局部增加。
经皮BPV是缓解严重肺动脉瓣狭窄的一种有效且安全的方法。超声心动图对右心室功能的分析显示，术后即刻整体收缩功能有所改善，而干预后24小时纵向收缩功能仍持续受损，这可能是由于需要更长的恢复时间。
