학술논문
MODERATED POSTER SESSION: Deformation and multimodality imaging in congenital heart: Thursday 4 December 2014, 08:30-18:00 * Location: Moderated Poster area
Document Type
Article
Author
West, C; Garcia-Aranda Dominguez, B; Alonso-Gonzalez, R; Li, W; Uebing, A; Cruz, C; Lebreiro, A; Pinho, T; Dias, C; Silva Cardoso, J; Julia Maciel, M; Pirat, B; Varan, B; Erdogan, I; Sade, LE; Muderrisoglu, H; Cruz, C; Lebreiro, A; Pinho, T; Dias, C; Silva Cardoso, J; Julia Maciel, M; Mateescu, A; Enache, R; Nastase, O; Botezatu, D; Popescu, BA; Ginghina, C; Di Salvo, G; D'aiello, AF; Del Gaizo, F; Rea, A; Capogrosso, C; Russo, MG; Capotosto, L; D'angeli, I; Placanica, A; Ashurov, R; Placanica, G; Tanzilli, G; Mangieri, E; Vitarelli, A; Grosse-Wortmann, L; Compton, G; Dragulescu, A; Nield, L; Ierano, P; Esposito, R; Santoro, C; De Stefano, F; Muscariello, R; Buonauro, A; Tufano, A; Galderisi, M; Cantinotti, M; Assanta, N; Crocetti, M; Marotta, M; Scalese, M; Molinaro, S; Murzi, B; De Lucia, V; Spadoni, I; Iervasi, G; Gaisenok, O; Martsevich, S YU; Deev, A D
Source
European Journal of Echocardiography; December 2014, Vol. 15 Issue: Supplement 2 pii78-ii78, 1p
Subject
Language
ISSN
15252167; 15322114
Abstract
Aim: There is wealth of data on the echocardiographic evaluation of prosthetic valves in the aortic or mitral position. Similar data are missing for the Melody percutaneous pulmonary valve system (MPPV). We aimed to correlate the anatomic appearance of the MPPV with the haemodynamic result on invasive and echocardiographic assessment. Patients and Methods: All 45 patients who underwent MPPV implantation at our institution between 2007-2013 were studied (median age 30 [range 11-61] years). All patients had complex congenital heart disease. The narrowest dimensions of the MPPV system were taken from the final biplane orthogonal fluoroscopic images to calculate the effective valve opening area (EOA). The post implantation invasive peak-to-peak gradient (ΔPp-p) and the maximal and mean Doppler gradient (ΔPmax and ΔPmean) on the pre-discharge echocardiogram (within 72 hours of implantation) were also obtained. Results: ΔPp-p after valve implantation was low (11.5±5.2 [range 2-20] mmHg) and there was no significant residual pulmonary regurgitation. The peak and mean gradient across the valve by Doppler assessment were significantly higher than ΔPp-p (ΔPmean: 19.3±6.5, ΔPmax: 33.3±8.2 mmHg; P<0.0001 for both vs. ΔPp-p). Both Doppler gradients correlated significantly with the invasive peak gradient (ΔPp-p vs. ΔPmean: r=0.37, P=0.03; ΔPp-p vs. ΔPmax: r=0.39, P=0.02) The EOA of the valve system indexed to body surface area was 132±30 mm2/m2. There were only weak relationships between the indexed EOA and the invasive and Doppler gradients (correlations with EOA: ΔPp-p: r=-0.32, P=0.06; ΔPpeak: r=-0.33, P=0.045; ΔPmean: r=-0.23; P=0.16). Conclusion: Doppler assessment of the percutaneous Melody valve early after implantation consistently overestimates the invasive peak-to-peak gradient. Simple estimates of valve size do not allow prediction of central haemodynamics. These results reflect the complex and variable anatomy of the right ventricular outflow tract/ main pulmonary artery in this group of patients.