This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan Correction (v55,p1767) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Harrild, D. M. Articles by McElhinney, D. B. Search for Related Content PubMed PubMed Citation Articles by Harrild, D. M. Articles by McElhinney, D. B. Related Collections Related Articles

CLINICAL RESEARCH: INTERVENTION IN CONGENITAL HEART DISEASE

Long-Term Pulmonary Regurgitation Following Balloon Valvuloplasty for Pulmonary Stenosis

Risk Factors and Relationship to Exercise Capacity and Ventricular Volume and Function

Departments of Cardiology, Children's Hospital Boston, and Pediatrics, Harvard Medical School, Boston, Massachusetts

Manuscript received October 28, 2009; revised manuscript received December 23, 2009, accepted January 2, 2010.

^_* Reprint requests and correspondence: Dr. David M. Harrild, Bader 2, Children's Hospital Boston, 300 Longwood Avenue, Boston, Massachusetts 02115 (Email: david.harrild{at}cardio.chboston.org).

Objectives: This study sought to examine the prevalence and predictors of pulmonary regurgitation (PR) following balloon dilation (BD) for pulmonary stenosis (PS) and to investigate its impact on ventricular volume and function, and exercise tolerance.

Background: Balloon pulmonary valvuloplasty relieves PS but can cause late PR. The sequelae of isolated PR are not well understood.

Methods: Patients were at least 7 years of age and 5 years removed from BD, and had no other form of congenital heart disease or significant residual PS. Cardiac magnetic resonance imaging and exercise testing were performed prospectively to quantify PR fraction, ventricular volumes and function, and exercise capacity.

Results: Forty-one patients underwent testing a median of 13.1 years after BD. The median PR fraction was 10%; 14 patients (34%) had PR fraction >15%; 7 (17%) had PR >30%. PR fraction was associated with age at dilation (ln-transformed, R = –0.47, p = 0.002) and balloon:annulus ratio (R = 0.57, p < 0.001). The mean right ventricular (RV) end-diastolic volume z-score was 1.8 ± 1.9; RV dilation (z-score 2) was present in 14/35 patients (40%). PR fraction correlated closely with indexed RV end-diastolic volume (R = 0.79, p < 0.001) and modestly with RV ejection fraction (R = 0.50, p < 0.001). Overall, peak oxygen consumption (VO ₂) (% predicted) was below average (92 ± 17%, p = 0.006). Patients with PR fraction >15% had significantly lower peak VO ₂ than those with less PR (85 ± 17% vs. 96 ± 16%, p = 0.03).

Conclusions: Mild PR and RV dilation are common in the long term following BD. A PR fraction >15% is associated with lower peak VO ₂, suggesting that isolated PR and consequent RV dilation are related to impaired exercise cardiopulmonary function.

Key Words: pulmonary regurgitation • exercise function • balloon valvuloplasty • pulmonary stenosis • right ventricular dilation

Abbreviations and Acronyms   BAR = balloon: annulus ratio   BD = balloon dilation   CMR = cardiac magnetic resonance   EF = ejection fraction   LV = left ventricle/ventricular   PR = pulmonary regurgitation   PS = pulmonary stenosis   RV = right ventricle/ventricular   TR = tricuspid regurgitation   VE/VCO2 = ratio of minute ventilation:carbon dioxide production   VO 2 = oxygen consumption

Related Articles

Balloon Pulmonary Valvuloplasty, Pulmonary Regurgitation, and Exercise Capacity: The Good, the Bad, and the Not Yet Clear

Larry A. Latson
J. Am. Coll. Cardiol. 2010 55: 1048-1049. [Full Text] [PDF]

This article has been cited by other articles:

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, G. K. Feld, B. H. Greenberg, J. Hall, M. Hlatky, W. Y. W. Lew, J. A. C. Lima, A. S. Maisel, et al. Highlights of the Year in JACC 2010 J. Am. Coll. Cardiol., January 25, 2011; 57(4): 480 - 514. [Full Text] [PDF]

				J. Rhodes, A. Ubeda Tikkanen, and K. J. Jenkins Exercise Testing and Training in Children With Congenital Heart Disease Circulation, November 9, 2010; 122(19): 1957 - 1967. [Full Text] [PDF]

				L. A. Latson Balloon Pulmonary Valvuloplasty, Pulmonary Regurgitation, and Exercise Capacity: The Good, the Bad, and the Not Yet Clear J. Am. Coll. Cardiol., March 9, 2010; 55(10): 1048 - 1049. [Full Text] [PDF]