Pulmonary Valve Regurgitation Research Articles

Unmet Clinical Needs for Transcatheter Pulmonary Valves.

A common feature of congenital heart disease is the presence of right ventricular outflow tract (RVOT) obstruction that can range from mild to severe and can lead to atresia of the pulmonary valve, in extreme conditions. RVOT abnormalities can frequently be corrected surgically or via interventional means. However, most of these patients will ultimately develop pulmonary valve insufficiency and eventual right ventricular dilation, which will require a pulmonary valve replacement at some point in their life to mitigate the detrimental effects of pulmonary valve regurgitation (PVR) on the right ventricle (RV). The evolution from the studies done by Philip Bonhoeffer to implant a pulmonary valve via transcatheter means, have provided a bedrock for transcatheter pulmonary valve replacement (TPVR). Yet, several areas of unmet need for a demographic of patients still exist. Here, we discuss the clinical unmet needs in children under 20 Kg and expand the use of hybrid and other TPVR approaches along with the current indications and contraindications for pulmonary valve replacement. The constraints and limitations from commercially available pulmonary valves will be discussed from a clinical standpoint. Finally, we explore the use of hybrid and periventricular delivery of transcatheter pulmonary valves in younger patients.

Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study.

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 (p = 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%, p = 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.

Pulmonary valve reconstruction for acquired pulmonary regurgitation in patients with treated congenital heart disease.

Pulmonary valve regurgitation is a common problem after relief of right ventricular outflow tract (RVOT) obstruction with a transannular patch. Pulmonary valve replacement with a homograft or xenograft is the routine treatment. Longevity of biological valves and the availability of homografts are limited. Alternatives to restore RVOT competence are evaluated. The goal of this study was to present intermediate-term results for pulmonary valve reconstruction (PVr) in patients with severe regurgitation. PVr was performed in 24 patients (August 2006‒July 2018). We analysed perioperative data, pre- and postoperative cardiac magnetic resonance (CMR) imaging studies, freedom from valve replacement and risk factors for pulmonary valve dysfunction. The underlying diagnoses were tetralogy of Fallot (n = 18, 75%), pulmonary stenosis (n = 5, 20.8%) and the double outlet right ventricle post banding procedure (n = 1, 4.2%). The median age was 21.5 (14.8-23.7) years. Main (n = 9, 37.5%) and branch pulmonary artery procedures (n = 6, 25%) and surgery of the RVOT (n = 16, 30.2%) were often part of the reconstruction. The median follow-up after the operation was 8.0 (4.7-9.7) years. Freedom from valve failure was 96% at 2 and 90% at 5 years. The mean longevity of the reconstructive surgery was 9.9 years (95% confidence interval: 8.8-11.1 years). CMR before and 6 months after surgery showed a reduction in the regurgitation fraction [41% (33-55) vs 20% (18-27) P = 0.00] and of the indexed right ventricular end-diastolic volume [156 ml/m2 (149-175) vs 116 ml/m2 (100-143), P = 0.004]. Peak velocity across the pulmonary valve (determined by CMR) half a year after surgery was 2.0, unchanged. PVr can be achieved with acceptable intermediate-term results and may delay pulmonary valve replacement.

Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model.

Right ventricular (RV) volume overload (VO) is common in children with congenital heart disease. In view of distinct developmental stages,the RV myocardium may respond differently to VO in children compared to adults. The present study aims to establish a postnatal RV VO model in mice using a modified abdominal arteriovenous fistula. To confirm the creation of VO and the following morphological and hemodynamic changes of the RV, abdominal ultrasound, echocardiography, and histochemical staining were performed for 3 months. As a result, the procedure in postnatal mice showed an acceptable survival and fistula success rate. In VO mice, the RV cavity was enlarged with a thickened free wall, and the stroke volume was increased by about 30%-40% within 2 months after surgery. Thereafter, the RV systolic pressure increased, corresponding pulmonary valve regurgitation was observed, and small pulmonary artery remodeling appeared. In conclusion, modified arteriovenous fistula (AVF) surgery is feasible to establish the RV VO model in postnatal mice. Considering the probability of fistula closure and elevated pulmonary artery resistance, abdominal ultrasound and echocardiography must be performed to confirm the model status before application.

4D Flow Cardiovascular Magnetic Resonance-Derived Flow Biomarkers for Early Detection of Flow Abnormalities: A Multicohort New Zealand Based Study

Four-dimensional (4D) flow cardiovascular magnetic resonance (4D flow CMR) imaging has evolved as a versatile imaging technique for the assessment of cardiovascular three-dimensional time resolved haemodynamics. This study aimed to examine the utility and metrics derived from 4D flow CMR in different patient cohorts. Controls (n=26), adult tetralogy of Fallot (rToF; n=14), and left ventricular hypertrophy (LVH; n=10) patients were scanned at the Centre of Advanced MRI, University of Auckland. Quantification of flow and examination of between-group differences were performed. Intraclass correlation coefficients (ICC) were used to correlate 4D and 2D CMR. Forward flow rates averaged in the pulmonary veins were significantly greater in LVH than controls (79.11±54.24 mL/sec vs 32.58±35.98 mL/sec, respectively, p<0.05), as was the pulmonary venous atrial reversal peak velocity (–0.44±0.23 m/sec vs –0.13±0.27 m/sec, respectively, p<0.05). Mitral indices of net flow and peak velocity expressed no significant between-group differences. In the rToF group, quantification of pulmonary artery and branches demonstrated a good correlation with 2D CMR. Greatest correlation was between pulmonary artery backward flow (difference of s–2.50±6.91 mL/cycle, ICC 0.96). In relation to pulmonary valve regurgitation categorisation, 1 of 14 cases were differently categorised using 4D flow (ICC 0.91). Quantification of flow with 4D flow CMR was feasible, with a single acquisition introducing an array of flow metrics that may be valuable for the evaluation of various conditions. Larger scale investigations of 4D flow CMR are required, with wider-scale application in routine clinical workflows.

Evaluación del tracto de salida del ventrículo derecho mediante resonancia magnética con flujo 4D en pacientes sometidos a recambio valvular pulmonar transcatéter

Introduction and objectivesMagnetic resonance imaging (MRI) including 4D flow is used before percutaneous pulmonary valve implantation (PPVI). As PPVI is limited by the size of the right ventricular outflow tract (RVOT), accurate sizing is needed to plan the intervention. The aim of this study was to compare different MRI modalities and invasive angiogram to balloon sizing of RVOT. MethodsSingle-centre prospective study of patients who underwent PPVI for isolated pulmonary regurgitation assessed by 4D flow MRI, 3D steady-state free precession/gradient echo (3D SSFP/GRE) and contrast magnetic resonance angiogram. Balloon sizing was considered as the reference. ResultsA total of 23 adults were included (mean age, 38.4±12.5 years). Eighteen patients underwent successful primary PPVI. The average of the narrowest RVOT diameter was 25.4±4.3mm by balloon sizing. Compared to balloon sizing, RVOT diameters were better correlated when estimated by systolic 4D flow MRI (r=0.89, P<0.001) than by diastolic 4D flow MRI (r=0.71, P<0.001), 3D contrast magnetic resonance angiography (r=0.73; P<.001) and 3D SSFP/GRE (r=0.50; P=.04) and not significantly correlated when estimated by 2D in diastole and systole. The mean difference between systolic 4D flow MRI and balloon sizing was 0.2mm (95%CI, –3.5 to 3.9 mm), whereas it was wider with other techniques. ConclusionsBeyond the quantification of pulmonary valve regurgitation, 4D flow allows accurate estimation of RVOT diameters, especially in systole, which is fundamental before planning PPVI.

Psychosis treatment in the context of tetralogy of Fallot and prolonged QTc

We present a case of a 27-year-old Caucasian male with a background of surgically corrected tetralogy of Fallot (TOF) and pulmonary valve regurgitation, who presented with psychotic symptoms. The case presented a challenge in treatment due to the patient's cardiac history and ongoing cardiac-related health problems with prolonged QTc before initiation of the antipsychotic drug. Treatment included careful monitoring of ECG while on antipsychotics, which led gradually to improvement in his mental state. The case highlights the possibility of a link between TOF and psychosis, the vulnerability of such patients to their treatment and the importance of multidisciplinary support for cardiac side-effects.

A mid- and long-team follow-up study of the application of single-valved bovine pericardium patches in right ventricular outflow tract reconstruction.

Pulmonary regurgitation following right ventricular outflow tract (RVOT) reconstruction may cause right heart dysfunction and even right heart failure. Installation of a single valve at this time point can effectively reduce pulmonary regurgitation, thereby protecting right heart function. Here, we analyzed the outcomes and mid- and long-term follow-up data of patients undergoing single-valved bovine pericardium patch (svBPP) placement for reconstruction and explored the effectiveness and gaps of svBPP in preventing right heart failure. A retrospective analysis was performed on patients undergoing RVOT reconstruction using BalMonocTM svBPP from October 2010 to August 2020. The follow up procedures included outpatient visits and collection of outcomes. The cardiac ultrasound-related indicators during the follow-up visits included ejection fraction (EF), right ventricular end-diastolic diameter (EDD), pulmonary regurgitation, and pulmonary artery stenosis. The survival rates and reoperation-free rate were analyzed by Kaplan-Meier method. Patients includes tetralogy of Fallot, pulmonary atresia and other complex congenital heart disease. A total of 5 patients (5.7%) died during the perioperative period. Early complications included pleural effusion, cardiac insufficiency, respiratory insufficiency, chylothorax, and atelectasis, all of which were cured. After discharge, 83 patients (94.3%) were effectively followed up. During follow-up, 1 patient died and 1 patient underwent reoperation. The 1-, 5-, and 10-year survival rates were 98.8%, 98.8%, and 98.8%, respectively, and the reintervention-free rates for the same intervals were 98.8%, 98.8%, and 98.8%, respectively. The last follow-up ultrasound revealed severe pulmonary stenosis in 0 cases, moderate stenosis in 2 cases, mild stenosis in 7 cases, and no stenosis in 73 cases. Pulmonary regurgitation was not found in 12 patients; however, there were 2 cases of severe pulmonary regurgitation, 20 cases of moderate pulmonary regurgitation, and 48 cases of mild pulmonary regurgitation. As shown in the mid- and long-term follow-up studies, BalMonocTM svBPP has good performance in RVOT reconstruction. It can effectively eliminate or reduce pulmonary valve regurgitation and protect right heart function. Both réparation à l'Etage ventriculaire (REV) and the modified Barbero-Marcial procedure can bring growth potential and reduce reoperation rate.

4D flow magnetic resonance imaging to assess right ventricular outflow tract in patients undergoing transcatheter pulmonary valve replacement

Introduction and objectivesMagnetic resonance imaging (MRI) including 4D flow is used before percutaneous pulmonary valve implantation (PPVI). As PPVI is limited by the size of the right ventricular outflow tract (RVOT), accurate sizing is needed to plan the intervention. The aim of this study was to compare different MRI modalities and invasive angiography to balloon sizing of RVOT. MethodsSingle-center prospective study of patients who underwent PPVI for isolated pulmonary regurgitation assessed by 4D flow MRI, 3D steady-state free precession/gradient echo (3D SSFP/GRE) and contrast magnetic resonance angiography. Balloon sizing was considered as the reference. ResultsA total of 23 adults were included (mean age, 38.4±12.5 years). Eighteen patients underwent successful primary PPVI. The average of the narrowest RVOT diameter was 25.4±4.3 mm by balloon sizing. Compared to balloon sizing, RVOT diameters were better correlated when estimated by systolic 4D flow MRI (r=0.89, P<.001) than by diastolic 4D flow MRI (r=0.71, P <.001), 3D contrast magnetic resonance angiography (r=0.73; P <.001) and 3D SSFP/GRE (r=0.50; P=.04) and was not significantly correlated when estimated by 2D in diastole and systole. The mean difference between systolic 4D flow MRI and balloon sizing was 0.2 mm (95%CI, –3.5 to 3.9 mm), whereas it was wider with other techniques. ConclusionsBeyond the quantification of pulmonary valve regurgitation, 4D flow allows accurate estimation of RVOT diameters, especially in systole, which is fundamental before planning PPVI.

IMMEDIATE AND EARLY OUTCOME OF PULMONARY VALVE CUSP AUGMENTATION FOR REPAIR OF TETRALOGY OF FALLOT (TOF)

Objectives: To determine the immediate and early outcome of pulmonary valve cusp augmentation for repair of tetralogy of Fallot (TOF)&#x0D; Methods: A descriptive study of 36 cases of TOF repair done from July 2020 to December 2022 at Faisalabad Institute of cardiology (FIC). Autologous pericardium used in all cases to augment the pulmonary valve cusp to increase the size of pulmonary valve orifice. Patients were followed in immediate and early post operative period by doing echocardiography to observe the outcome including pulmonary valve regurgitation (PR), stenosis and right ventricular outflow tract obstruction (RVOTO)&#x0D; Results: Median age was 12 years (4–21). Immediate Post repair echocardiography showed no PR in 77.8 % of patients (n=28) while 8 patients had mild PR (22.2%). Majority of patients (61.1%) had mild RVOT obstruction, 13 patients (36.1%) had moderate RVOT obstruction while one patient had severe RVOT obstruction. Mean gradient across RVOT was 36.72 (+/- 11.08). The data on most recent follow up showed no PR in 83.3% (n=30) patients, while 6 patients (16.7%) had mild pulmonary regurgitation. Mild RVOTO was seen in 47.2 % of patients (n=17), 50% (n=18) patients had moderate RVOTO while one patient had severe RVOTO. Mean RVOT gradient was 40.8 +/- 15.20. There was no statistically significant difference between immediate and at last follow up RVOT gradient (p-value = 0.119)&#x0D; Conclusion: Augmentation of the pulmonary valve cusp in selective cases of TOF is a useful technique to avoid the need of transannular patch in significant number of cases&#x0D; Keywords: Tetralogy of Fallot, right ventricular outflow tract, cusp augmentation, transannular.&#x0D;

Benefits of synthetic monocusp application in radical correction of Tetralogy of Fallot: early postoperative results

Tetralogy of Fallot (TF) has a worldwide prevalence of approximately 1 in 3000 live newborns, thus representing the most common cyanogenic cardiac malformation. The type of radical correction approached depends on the severity of right ventricular outflow tract (RVOT) stenosis, which is assessed depending on the Z-score of the pulmonary artery valve annulus (PAV). TF with a Z score &lt; -3, requires PAV widening plasty with transannular application of the autologous pericardial patch. Pulmonary valve regurgitation is the most frequent and severe complication of this type of radical correction, especially in the early postoperative period. The use of a monocusp at the level of the pulmonary artery valve could reduce this phenomenon.

Visibility of Pulmonary Valve and Pulmonary Regurgitation on Intracardiac Echocardiography in Adult Patients with Tetralogy of Fallot.

Pulmonary regurgitation (PR) is a risk factor for sudden cardiac death in adult patients with repaired tetralogy of Fallot (TOF). However, transthoracic echocardiography (TTE) cannot fully visualize the pulmonary valve (PV) and PR. We investigated whether intracardiac echocardiography (ICE) could visualize the PV and PR better than TTE. Thirty adult patients with TOF (mean age 33 ± 15 years) scheduled for cardiac catheterization underwent ICE. The visualization of PV and the severity of PR were classified into three grades. ICE depicted the PV better than TTE (ICE vs. TTE: not visualized, partially visualized, and fully visualized: n = 1 [3%], n = 13 [43%], and n = 16 [53%] vs. n = 14 [47%], n = 13 [43%], and n = 3 [10%], p &lt; 0.001). Especially in patients after pulmonary valve replacement (PVR), the PV was more fully visualized by ICE. The assessment of PR by TTE underestimated the severity of PR in comparison to cardiac magnetic resonance imaging (MRI) (severe PR: 8 [28%] vs. 22 [76%], p = 0.004), while there was no discrepancy between the results of ICE and MRI (21 [72%] vs. 22 [76%], p = 1.000). In comparison to TTE, ICE can safely provide better visualization of the PV and PR in adults with TOF, especially in patients who have undergone PVR.

Left ventricle dysfunction in patients with critical neonatal pulmonary stenosis: echocardiographic predictors. A single-center retrospective study.

The aim of this study is to identify echocardiographic predictors of transient left ventricle dysfunction after pulmonary valve balloon dilatation (PVBD), in neonates with pulmonary valve stenosis (PVS) and atresia with intact septum (PAIVS) at birth. The study includes patients admitted at the Bambino Gesù Children Hospital from January 2012 to January 2017. Clinical, echocardiographic and cardiac catheterization data before and after PVBD were retrospectively analyzed. Twenty-nine infants were included in the study (21 male and eight female). The median age was 5.8 ± 7.1 days. Eight patients developed transient LV dysfunction (three PAIVS and five PVS) and comparing data before and after the procedure, there was no difference in right ventricle geometrical and functional parameters except for evidence of at least moderate pulmonary valve regurgitation after PVBD. Moderate to severe degree pulmonary valve regurgitation was significant associated to LV dysfunction (p < 0.05) in PVS and PAIVS patients.

Valvular and aortic surgery in an adult patient late after repaired tetralogy of Fallot

BackgroundThe most common complication after tetralogy of Fallot repair is pulmonary valve regurgitation. However, concomitant surgery for tricuspid valve regurgitation and/or aortic dilatation is occasionally required.Case presentationA 56-year-old woman who underwent surgery for tetralogy of Fallot at age 29 years was diagnosed with progressive tricuspid valve regurgitation, hepatosplenomegaly, and thrombocytopenia. Moreover, computed tomography and transesophageal echocardiography revealed regurgitation in pulmonary and mitral valves and dilatation of the ascending aorta. One month after splenectomy for increasing platelet count, she underwent pulmonary valve replacement, tricuspid and mitral valve annuloplasty, and ascending aortic replacement. Postoperatively, the intensive care stay was complicated because of ventricular dysfunction and long-term ventilation. After 1 week, the patient was disconnected from the respirator, and she was transferred on the 55th postoperative day to another hospital for rehabilitation, without permanent disabilities.ConclusionWe herein reported a patient with repaired TOF who successfully underwent PVR, tricuspid and mitral valve annuloplasty, and ascending aortic replacement.

Right ventricular echocardiographic remodeling after pulmonary valve replacement in repaired Tetralogy of Fallot

BackgroundMany patients with repaired tetralogy of Fallot require reoperation in the medium to long-term for residual pulmonary valve regurgitation. Best timing for pulmonary valve replacement remains controversial. A balance needs to be found between protecting the patients from permanent right ventricular damage and insertion of a prosthetic valve with its inherent issues. In the current study we sought to investigate the right and left ventricular functional recovery following valve replacement in our tertiary care institution. ResultsIn a retrospective cross-sectional study patients with history of total correction of tetralogy of Fallot who had undergone pulmonary valve replacement due to severe pulmonary regurgitation between 2003–2018 were evaluated for post intervention right and left ventricular functional recovery. Clinical and full echocardiographic data before and after the surgery were recorded and compared. There was statistically significant improvement in RV size and function post pulmonary valve replacement. There was no statistically significant improvement in left ventricular systolic function. Twenty percent of patient had persisting severe right ventricular enlargement at least twelve months post-surgery. No patient had fully normalized right ventricular size and function in follow-up. ConclusionsPulmonary valve replacement leads to improvement in right ventricular size and function in patients with repaired tetralogy of Fallot. However normalization of functional parameters did not occur and the majority of the patients have residual right and left ventricular dysfunction following redo valve replacement surgery.

Long-term results of balloon pulmonary valvuloplasty in pediatric age group in surgical specialty teaching hospital/cardiac center/Hawler

Congenital valvular pulmonary stenosis accounts for 5-10% of all congenital heart disease. Balloon pulmonary valvuloplasty is a safe and effective method in reduction of moderate to severe valvular pulmonary stenosis. This retrospective study done in Hawler surgical specialty cardiac center on pediatric patients who had pulmonary valve stenosis (with echocardiographic peak gradient 2:50mmHg) and treated by balloon pulmonary valvuloplasty. A total of 178 cases were involved, 93(52.25%) patient was male and 85 (47.75%) patients was female. 160 patient (89.89%) were treated with single balloon method 18 patient (10.11%) were managed by double balloon method technique. Follow up period of these patients range from 1 year to 10 years (mean of 5.5 year). In 153 patients (85.96%) pressure across pulmonary valve were below 36 mm Hg, while in 21 (11.80%) pressure gradient across pulmonary valve were (36-50 mm Hg). Four (2.24%) patients had pressure gradient across pulmonary valve more than 50 mm Hg. Forty patients (22.47%) developed mild pulmonary valve regurgitation, while 20 patient (11.24%) developed significant pulmonary valve regurgitation. Balloon pulmonary valvuloplasty provides long-term relief of pulmonary valvular obstruction in the majority of pediatric patients. The long-term results are favorable.

Absent Single Pulmonary Cusp Causing Isolated Pulmonary Valvar Regurgitation

Isolated congenital pulmonary valve regurgitation (IPVR) is very rare. Absent/ bicuspid/ dysplastic pulmonary valves are the common congenital causes of this condition. Here we present a rare cause of IPVR caused by absent single pulmonary cusp. A review of literature to establish timing and management of isolated pulmonary regurgitation is also attempted.

Progress on the application of transcatheter pulmonary valve replacement in autogenous right ventricular outflow tract pulmonary valve regurgitation

右心室流出道功能障碍是成人先天性心脏病术后常见的血流动力学后遗症，因右心室流出道功能不全而再次手术较为常见。虽然外科手术的风险较低，但其创伤大、恢复慢、患者心理负担重，且未来再次手术的风险会随着手术次数增多而逐渐增加。对于这一类患者，经导管肺动脉瓣置换术是一种新的选择。随着技术的不断发展，新的经导管肺动脉瓣膜使得应用经导管瓣膜置换技术治疗这类患者成为可能。目前，右心室-肺动脉管道及生物肺动脉瓣的经导管肺动脉瓣置换术已经积累了较为丰富的经验，远期随访也得到了较好的血流动力学参数。然而，目前的技术不能完全解决具有复杂形态的自体右心室流出道功能障碍。该文描述了自体右心室流出道的复杂解剖形态、目前可用的经导管肺动脉瓣膜系统及未来发展中存在的问题。.

Role of computed tomography in transcatheter replacement of ‘other valves’: a comprehensive review of preprocedural imaging

Transcatheter procedures for heart valve repair or replacement represent a valid alternative for treating patients who are inoperable or at a high risk for open-heart surgery. The transcatheter approach has become predominant over surgical intervention for aortic valve disease, but it is also increasingly utilized for diseases of the 'other valves', that is the mitral and, to a lesser extent, tricuspid and pulmonary valve. Preprocedural imaging is essential for planning the transcatheter intervention and computed tomography has become the main imaging modality by providing information that can guide the type of treatment and choice of device as well as predict outcome and prevent complications. In particular, preprocedural computed tomography is useful for providing anatomic details and simulating the effects of device implantation using 3D models. Transcatheter mitral valve replacement is indicated for the treatment of mitral regurgitation, either primary or secondary, and computed tomography is crucial for the success of the procedure. It allows evaluating the mitral valve apparatus, the surrounding structures and the left heart chambers, identifying the best access route and the landing zone and myocardial shelf, and predicting obstruction of the left ventricular outflow tract, which is the most frequent postprocedural complication. Tricuspid valve regurgitation with or without stenosis and pulmonary valve stenosis and regurgitation can also be treated using a transcatheter approach. Computer tomography provides information on the tricuspid and pulmonary valve apparatus, the structures that are spatially related to it and may be affected by the procedure, the right heart chambers and the right ventricular outflow tract.

Measurement of ANP, BNP and endothelin‐1 concentrations in jumping horses with heart valvular regurgitation and their correlation with the dimensions of heart structures

SummaryBackgroundNatriuretic peptides and endothelin‐1 are used as biochemical biomarkers for the diagnosis and prognosis of heart diseases.ObjectivesThis study aimed to investigate plasma ANP, BNP and endothelin‐1 in jumping horses with various manifestations of heart valve regurgitation and their association with echocardiographic variables.Study designClinical evaluations including cardiac auscultation were performed in 198 jumping horses, and 30 horses were chosen.MethodsSixteen jumping horses with murmurs of grade 3/6 to 5/6 having various degrees of heart valve regurgitation with the severity of insignificant to moderate on colour Doppler echocardiography were considered as the valvular regurgitation group (average age 9.75 ± 3.28 years and weight 427.43 ± 82.22 kg, and consisting of 10 mares, three stallions and three castrated male horses with breeds of 12 Thoroughbred and four crossbred). Fourteen healthy horses were chosen as the healthy group (average age 8.64 ± 2.44 years and weight 462.14 ± 77.42 kg, and consisting of nine mares, three stallions and two castrated males with breeds of 12 Thoroughbreds, and two crossbred). Blood samples were collected from the jugular vein, and plasma concentration of ANP, BNP and endothelin‐1 was determined using Sandwich ELISA by a horse‐specific kit. Then, the plasma concentration of mentioned peptides and echocardiographic variables were compared between the two groups.ResultsB‐type natriuretic peptide was significantly increased in horses with valve regurgitation compared to healthy horses, but increases in ANP and endothelin‐1 were insignificant. Also, in the valvular regurgitation group, horses with a pulmonic valve disorder had a significantly higher concentration of BNP and endothelin‐1 than healthy horses. Assessment of the relation between ANP, BNP and endothelin‐1 with echocardiographic variables showed a significant correlation between ANP and right ventricle length (RVL) and left ventricle width (LVW) in systole and endothelin‐1 with right ventricle width (RVW) and left ventricle width in systole, but BNP had no significant correlation.Conclusion and clinical importanceAccording to the study results, it can be assumed that the measurement of these cardiac biomarkers can be helpful in the diagnosis of the jumping horse with cardiac valvular disorders (especially pulmonic valve regurgitation) and changes in the dimensions of the heart ventricle.