Abstract 2612: Immediate Clinical And Hemodynamic Benefits Of Restoration Of Pulmonary Valvar Competence In Patients With Pulmonary Hypertension

Abstract

Background: In patients with severe pulmonary hypertension (PH), chronic pressure overload leads to right heart failure, the main reason for clinical deterioration and mortality. In the presence of pulmonary regurgitation (PR), right ventricular (RV) efficiency and cardiac output are further compromised. Therapeutic options in this patient group are limited due to the high risk of open-heart surgery in the presence of the PH. Percutaneous pulmonary valve implantation (PPVI) may offer a new treatment option for relief of PR without the risk of cardiopulmonary bypass. Methods: Between April 2004 to December 2007, 7 patients with PH (mean PAP > 25 mmHg) due to congenital heart disease and severe PR underwent PPVI. Patients were assigned to New York Heart Association (NYHA) functional classes I – IV. Resting peripheral oxygen saturations were measured. Trans-thoracic echocardiography and magnetic resonance imaging before and after valve implantation was performed. Results: The valve implantation procedure was feasible and uncomplicated in all 7 cases, successfully abolishing PR. There was a significant increase in diastolic (15.4±7.3 to 34.0±8.5 mmHg; p=0.007) and mean (29.7±8.1 to 41.3±12.9 mmHg; p=0.034) pulmonary artery pressures, and an improvement in NYHA functional class (from median IV to median III; p<0.008). Peripheral oxygen saturations rose from 85.9±11.0% to 91.7±8.3% (p=0.036). RV end-diastolic volumes decreased (from 157.0±44.7 to 140.3±53.3 ml/m 2 ), whilst effective RV stroke volume increased (from 23.4±9.3 to 41.0±11.6 ml/m 2 ). During a median follow-up of 20.3 months (range 1.3 – 47.5), competence of the bovine jugular venous valve was well maintained despite near systemic pulmonary pressures. None of the devices were explanted during follow-up. Conclusion: Trans-catheter abolishment of PR in patients with PH is well tolerated and leads to clinical and haemodynamic improvement, most likely due to a combination of increased pulmonary perfusion pressures and RV efficiency. These findings emphasize the detrimental effects of volume overload in chronically pressure overloaded right ventricles.