IMPACTS OF THE SYSTEMIC RIGHT VENTRICULAR TRABECULAE AND PAPILLARY MUSCLES ON VOLUMES AND FUNCTION ASSESSED BY NOVEL MAGNETIC RESONANCE ALGORITHM

Abstract

BACKGROUND: Procedural rapid ventricular pacing (RVP) and transoesophageal echocardiography (TOE) guidance have been well established in the transcatheter aortic valve replacement field. However, scarce data exist on the use of these techniques for transcatheter treatment of congenital aortic stenosis. METHODS: Charts of all patients undergoing balloon aortic valvuloplasty from January 1995 to January 2015 at the Centre Hospitalier de l’Universite Laval in Quebec City were reviewed. Statistical analyses between groups were done by univariate studies. Cox regression analysis was used to evaluate factors influencing freedom from surgery. RESULTS: Sixty-one patients (37 males; 24 females) with a mean age of 7.2 11.5 years and a mean gradient of 58 21 mmhg underwent 71 balloon aortic valvuloplasty. The mean follow-up period is 4.9 4.9 years. Fourteen balloon valvuloplasty (19.7%) were done on patients <1 month and 22 (31%) on patients between 1 month and 1 year of age. Twenty-six procedures (37%) were on patients with associated left sided lesions, fibroelastosis or pulmonary stenosis (2 patients). Three patients had an aortic valve Z-score h -2. At last follow-up, 20 (32%) patients have required surgery: 8 for aortic insufficiency, 9 for residual stenosis and 2 for a mixed lesion. Since August 2006, rapid pacing has been used in 20 procedures, which represents 28% of the overall cohort and 82% of the procedures done after 08-2006. The use of rapid pacing was associated with a shorter procedure time (112 11 vs 79 5 min p1⁄40.008), and a tendency towards requiring less surgical intervention on follow-up (p1⁄40.08). Since January 2004, determination of balloon diameter has relied on valve annulus measurement done per procedure by TOE (40/51 procedures; 78%). The use of TOE was associated with less complications (7 vs 32% p1⁄40.01). Significant aortic insufficiency, on early follow up transthoracic echocardiogram, was the only predictor of the need of a surgical aortic procedure at median term follow-up (p1⁄40.002). CONCLUSION: The use of TOE guidance and RVP improved the results of balloon aortic valvuloplasty in congenital patients. This may have a major impact on the need for surgical procedures in these patients. Larger studies with a longer follow-up are needed to confirm these results. 059 IMPACTS OF THE SYSTEMIC RIGHT VENTRICULAR TRABECULAE AND PAPILLARY MUSCLES ON VOLUMES AND FUNCTION ASSESSED BY NOVEL MAGNETIC RESONANCE ALGORITHM