Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T12:16:18.974Z Has data issue: false hasContentIssue false
  • English
  • Français

Restrictive right ventricular performance assessed by cardiac magnetic resonance after balloon valvuloplasty of critical pulmonary valve stenosis

Published online by Cambridge University Press:  22 June 2015

Ikram Massoud ,
Nader Botros ,
Atef Yehia ,
Hassan Abdelghafoor ,
Mohamed Donya ,
Ahmd Samir ,
Heba Serag  and
Elham Mohamed
Ikram Massoud*
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Nader Botros
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Atef Yehia
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Hassan Abdelghafoor
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Mohamed Donya
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Ahmd Samir
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Elham Mohamed
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
*
Correspondence to: Dr I. E. Massoud, Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Cairo 11728, Egypt. Tel: +0 020 100 177 9650; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Little data are published about right ventricular diastolic performance in patients with critical pulmonary valve stenosis after balloon pulmonary valvuloplasty thus far.

Methods

A total of 44 patients with isolated critical pulmonary valve stenosis who had undergone balloon valvuloplasty with haemodynamic recordings were enrolled to the study; 33 patients who came for follow-up underwent further imaging by echocardiography after 6 months and their right ventricular functional parameters were compared with 33 control patients of the same age and sex. Out of 33 patients, 21 underwent cardiac MRI with late gadolinium enhancement to assess the presence of right ventricular fibrosis.

Results

The right ventricular systolic pressure (p<0.0001) and right ventricular outflow tract gradient (p<0.0001) decreased acutely (p<0.0001) after balloon valvuloplasty. During follow-up, M-mode left ventricular end diastolic dimension (p<0.001) and end systolic dimension increased (p<0.001), whereas right ventricular end diastolic dimension decreased (p<0.001). Compared with controls, patients (n=33) had significantly reduced tricuspid annular Ea and higher E/Ea (p<0.001). Right ventricular systolic dysfunction was also suggested by reduced tricuspid annular systolic velocity (p<0.001). Late gadolinium enhancement was demonstrated in 13 out of 21 patients with restrictive physiology, which involves the anterior right ventricular outflow tract, anterior wall, and inferior wall. The right ventricular late gadolinium enhancement score correlated positively with age (r=0.7, p<0.001) and right ventricular mass index (r=0.52, p<0.001).

Conclusion

The persistence of right ventricular diastolic dysfunction after relief of chronic pressure overload of critical pulmonary valve stenosis suggests that a factor – other than increase in afterload – is involved in this physiology. Fibrosis is the most likely factor responsible for persistence of restrictive physiology as documented by late gadolinium enhancement.

Keywords

Restrictive right ventricular physiologytissue Dopplerlate gadolinium enhancement
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Supplement 3 , March 2016 , pp. 556 - 568
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
2. Kan, JS, White, RI Jr, Mitchell, SE, Gardner, TJ. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary-valve stenosis. N Engl J Med 1982; 307: 540–542.CrossRefGoogle ScholarPubMed
3. Right Ventricular Hypertrophy-Wikipedia, the free encyclopedia. en.Wikipedia.org/Wiki/Right_Ventricular_hypertrophy.Google Scholar
4. Redington, AN, Penny, D, Rigby, ML, Hayes, A. Antegrade diastolic pulmonary artery flow as a marker of right ventricular restriction after complete repair of pulmonary atresia with intact ventricular septum and critical pulmonary valve stenosis. Cardiol Young 1992; 2: 382–386.CrossRefGoogle Scholar
5. Horton, KD, Meece, RW, Hill, JC. Assessment of the right ventricle by echocardiography: a primer for cardiac sonographers. J Am Soc Echocardiogr 2009; 22: 776–792.CrossRefGoogle Scholar
6. Cullen, S, Shore, D, Redington, AN. Characterisation of right ventricular diastolic performance after complete repair of tetralogy of Fallot restrictive physiology predicts slow postoperative recovery. Circulation 1995; 91: 1782–1789.CrossRefGoogle ScholarPubMed
7. Kisanuki, A, Tei, C, Otsuji, Y, et al. Doppler echocardiographic documentation of diastolic pulmonary artery forward flow. Am J Cardiol 1987; 59: 711–713.CrossRefGoogle ScholarPubMed
8. Babu-Narayan, SV, Goktekin, O, Moon, JC, et al. Late gadolinium enhancement cardiovascular magnetic resonance of the systemic right ventricle in adults with previous atrial redirection surgery for transposition of the great arteries. Circulation 2005; 26: 2091–2098.CrossRefGoogle Scholar
9. Rathi, VK, Biederman, RW. Expanding role of cardiovascular magnetic resonance in left and right ventricular diastolic function. Heart Fail Clin 2009; 5: 421–435.CrossRefGoogle ScholarPubMed
10. Al Kassab, S, Ribeiro, PA, AlZaibag, M, Halim, M, Shahid, M. Percutaneous double balloon pulmonary valvotomy in adults: one- to two-year follow-up. Am J Cardiol 1988; 62: 822–824.CrossRefGoogle Scholar
11. Park, JH, Yoon, YS, Yeon, KM, et al. Percutaneous pulmonary valvuloplasty with a double-balloon technique. Radiology 1987; 164: 715–718.CrossRefGoogle ScholarPubMed
12. Matsukubo, H, Matsuura, T, Endo, N, Asayama, J, Watanbe, T. Echocardiographic measurement of right ventricular wall thickness. A new application of subxiphoid echocardiography. Circulation 1977; 56: 278–284.CrossRefGoogle ScholarPubMed
13. Kampmann, C, Wiethoff, CM, Wenzel, A, et al. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart 2000; 83: 667–672.CrossRefGoogle ScholarPubMed
14. Pettersen, MD, Wei, DU, Skeens, ME, Humes, RA. Regression equations for calculation of Z scores of cardiac structures in a large cohort healthy infants, children an adolescents: an echocardiographic study. J Am Soc Echocardiogr 2008; 21: 922–934.CrossRefGoogle Scholar
15. De Ruijter, FT, Weenin, KI, Hitchcock, FJ, Meijboom, EJ, Bennink, GB. Right ventricular dysfunction and pulmonary valve replacement after correction of tetralogy of Fallot. Ann Thorac Surg 2002; 73: 1794–1800.CrossRefGoogle ScholarPubMed
16. Johnson, GL, Kwan, OL, Handshoe, S, Noonan, JA, DeMaria, A. Accuracy of combined two-dimensional echocardiography and continuous wave Doppler recordings in the estimation of pressure gradient in right ventricular outlet obstruction. J Am Coll Cardiol 1984; 3: 1013–1018.CrossRefGoogle ScholarPubMed
17. Silvilairat, S, Cabalka, AK, Cetta, F, Hagler, DJ, O’Leary, PW. Echocardiographic assessment of isolated pulmonary valve stenosis: which outpatient Doppler gradient has the most clinical validity? J Am Soc Echocardiogr 2005; 18: 1137–1142.CrossRefGoogle ScholarPubMed
18. Lam, YY, Kaya, MG, Goktekin, O, Gatzoulis, MA, Henein, MY, Li, W. “Isolated” diastolic dysfunction in left ventricular outflow tract obstruction. Am J Cardiol 2006; 98: 509–514.CrossRefGoogle ScholarPubMed
19. Lam, YY, Kaya, MG, Goktekin, O, Gatzoulis, MA, Li, W, Henein, MY. Restrictive right ventricular physiology: its presence and symptomatic contribution in patients with pulmonary valvular stenosis. J Am Coll Cardiol 2007; 50: 1491–1497.CrossRefGoogle ScholarPubMed
20. Nageh, MF, Kopelen, HA, Zoghbi, WA, Quinones, MA, Nagueh, SF. Estimation of mean right atrial pressure using tissue Doppler imaging. Am J Cardiol 1999; 84: 1448–1451.CrossRefGoogle ScholarPubMed
21. Babu-Narayan, SV, Kilner, PJ, Li, W, et al. Ventricular fibrosis suggested by cardiovascular magnetic resonance in adults with repaired tetralogy of Fallot and its relationship to adverse markers of clinical outcome. Circulation 2006; 113: 405–413.CrossRefGoogle ScholarPubMed
22. Lorenz, CH. The range of normal values of cardiovascular structures in infants, children, and adolescents measured by magnetic resonance imaging. Pediatr Cardiol 2000; 21: 37–46.CrossRefGoogle ScholarPubMed
23. Pennell, DJ. Ventricular volume and mass by CMR. J Cardiovasc Magn Reson 2002; 4: 507–513.CrossRefGoogle ScholarPubMed
24. Atherton, JJ, Moore, TD, Lele, SS, et al. Diastolic ventricular interaction in chronic heart failure. Lancet 1997; 349: 720–724.CrossRefGoogle ScholarPubMed
25. Liang, XC, Lam, WW, Cheung, EW, Wu, AK, Wong, SJ, Cheung, YF. Restrictive right ventricular physiology and right ventricular fibrosis as assessed by cardiac magnetic resonance and exercise capacity after biventricular repair of pulmonary. Clin Cardiol 2010; 33,2: 104–110.CrossRefGoogle Scholar
26. Gatzoulis, MA, Clark, AL, Cullen, S, Newman, CG, Redington, AN. Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot: restrictive physiology predicts superior exercise performance. Circulation 1995; 91: 1775–1781.CrossRefGoogle ScholarPubMed
27. Choudhury, L, Mahrholdt, H, Wagner, A, et al. Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 40: 2156–2164.CrossRefGoogle ScholarPubMed
28. Moon, JC, Reed, E, Sheppard, MN, et al. The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol 2004; 43: 2260–2264.CrossRefGoogle ScholarPubMed
29. Munkhammar, P, Cullen, S, Jogi, P, et al. Early age at repair prevent restrictive right ventricular (RV) physiology after surgery for tetralogy of Fallot (TOF): diastolic RV function after TOF repair in infancy. J Am Coll Cardiol 1998; 32: 1083–1087.CrossRefGoogle ScholarPubMed
30. Norgard, G, Gatzoulis, MA, Moraes, F, et al. Relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot: implications for long-term outcome. Circulation 1996; 94: 3276–3280.CrossRefGoogle ScholarPubMed
31. Mertens, LL, Friedberg, MK. Imaging the right ventricle-current state of the art. Nat Rev Cardiol 2010; 7: 551–563.CrossRefGoogle ScholarPubMed

Massoud supplementary material

Massoud supplementary material 1

Download Massoud supplementary material(Video)
Video 300.9 KB

Massoud supplementary material

Massoud supplementary material 2

Download Massoud supplementary material(Video)
Video 423.4 KB

Massoud supplementary material

Massoud supplementary material 3

Download Massoud supplementary material(Video)
Video 348.4 KB

Massoud supplementary material

Massoud supplementary material 4

Download Massoud supplementary material(Video)
Video 1 MB

Massoud supplementary material

Massoud supplementary material 5

Download Massoud supplementary material(Video)
Video 750.6 KB

Massoud supplementary material

Massoud supplementary material 6

Download Massoud supplementary material(Video)
Video 1 MB

Massoud supplementary material

Massoud supplementary material 7

Download Massoud supplementary material(Video)
Video 389.4 KB

Massoud supplementary material

Massoud supplementary material 8

Download Massoud supplementary material(Video)
Video 750.6 KB

Massoud supplementary material

Massoud supplementary material 9

Download Massoud supplementary material(Video)
Video 774.4 KB

Massoud supplementary material

Massoud supplementary material 10

Download Massoud supplementary material(Video)
Video 815 KB