Soszyn Natalie, Yuen Gabriel, Franco Salvador R, von Alvensleben Johannes C, Morgan Gareth J, Zablah Jenny E
School of Medicine, Children's Hospital Colorado, The Heart Institute, University of Colorado Denver|Anschutz Medical Campus, 13123 E 16Th Ave, Box 100, Aurora, CO, 80045-2560, USA.
The Heart Institute, Children's Hospital Colorado, 13123 E 16Th Ave, Box 100, Aurora, CO, 80045-2560, USA.
Pediatr Cardiol. 2025 Jan 20. doi: 10.1007/s00246-024-03767-4.
Though major complications during transcutaneous pulmonary valve replacement (TPVR) are rare, clinically-significant ventricular arrythmia (CSVA) has been reported following self-expanding valve placement. We assess whether alterations in valve frame dimensions and geometry within the right ventricular outflow tract (RVOT) post-implantation in patients who underwent TPVR with Harmony TPV25 or Alterra contribute to CSVA risk. A single center review was performed of patients who underwent TPVR with either Harmony TPV25 or Alterra Pre-stent between August 2019 and April 2023. Using post-procedural 3D rotational acquisitions, minimum and maximum diameters were measured at 5 locations along the valve frame and perimeter and cross-sectional area (CSA) were measured closest to the pulmonary artery bifurcation and right ventricular (RV) cavity. To assess the relationship between the RVOT and valve frame, a RVOT-to-valve frame ratio together with percentage expansion, circularity and expansion ratios, and eccentricity indices were calculated. Twenty-eight patients were included (14 Harmony TPV25, 14 Alterra pre-stent). CSVA was seen more often in patients with congenital pulmonary stenosis (p = 0.02). CSVA was associated with a larger mean valve frame perimeter (118.3 vs 108.6 mm, p = 0.03) and CSA (1124.5 vs 926.2mm, p = 0.03) closest to the RV cavity. No associations between difference in diameters, RVOT-to-valve frame ratio, parameters evaluating valve frame geometry, and level of implant and CSVA were demonstrated. No single mechanism was identified that contributed to CSVA in patients following self-expanding valve implantation. Future studies implementing these mathematical constructs and measurements to a larger cohort of self-expanding valve patients may yield more instructive results.
尽管经皮肺动脉瓣置换术（TPVR）期间的主要并发症很少见，但在自膨胀瓣膜置入后已有临床显著室性心律失常（CSVA）的报道。我们评估了接受Harmony TPV25或Alterra经皮肺动脉瓣置换术的患者植入后右心室流出道（RVOT）内瓣膜框架尺寸和几何形状的改变是否会增加CSVA风险。对2019年8月至2023年4月期间接受Harmony TPV25或Alterra预支架经皮肺动脉瓣置换术的患者进行了单中心回顾。使用术后三维旋转采集，在瓣膜框架的5个位置测量最小和最大直径，并在最靠近肺动脉分叉和右心室（RV）腔处测量周长和横截面积（CSA）。为了评估RVOT与瓣膜框架之间的关系，计算了RVOT与瓣膜框架的比值以及扩张百分比、圆度和扩张率，以及偏心指数。纳入28例患者（14例Harmony TPV25，14例Alterra预支架）。先天性肺动脉狭窄患者CSVA的发生率更高（p = 0.02）。CSVA与最靠近RV腔的平均瓣膜框架周长较大（118.3 vs 108.6 mm，p = 0.03）和CSA较大（1124.5 vs 926.2mm，p = 0.03）相关。未发现直径差异、RVOT与瓣膜框架比值、评估瓣膜框架几何形状的参数以及植入水平与CSVA之间存在关联。在自膨胀瓣膜植入术后的患者中，未发现导致CSVA的单一机制。未来对更大规模自膨胀瓣膜患者队列实施这些数学结构和测量的研究可能会产生更具指导意义的结果。
