Francesco Secchi MD, Presenter: Nothing to Disclose

Francesca Romana Pluchinotta MD, Abstract Co-Author: Nothing to Disclose

Paola Maria Cannao MD, Abstract Co-Author: Nothing to Disclose

Gianfranco Butera, Abstract Co-Author: Nothing to Disclose

Massimo Lombardi MD, Abstract Co-Author: Nothing to Disclose

Francesco Sardanelli MD, Abstract Co-Author: Speakers Bureau, Bracco Group Research Grant, Bracco Group Speakers Bureau, Bayer AG Research Grant, Bayer AG Research Grant, IMS International Medical Scientific

Mario Carminati MD, Abstract Co-Author: Nothing to Disclose

Percutaneous pulmonary valve implantation (PPVI) is an alternative to surgical pulmonary valve replacement (SPVR) in select patients with congenital right ventricular outflow tract (RVOT) obstruction. Objective of this study is to evaluate the medium-term impact of PVVI and SPVR on biventricular function as assessed by cardiac magnetic resonance (CMR).

From 2008 to 2013, 33 patients (median 20 years) underwent PPVI while 16 patients (median 30 years) underwent SPVR. CMR (1.5 T) acquired before and after an average of 10 months (range 3-15) were analyzed, and post- versus pre- pulmonary valve replacement findings were compared. Cine true-FISP sequence was performed (TR/TE=45/1.5 ms, thickness 8 mm) to study the right (RV) and left ventricles (LV) function. MR angiography after administration of contrast material (0.01 mmol/kg Gd-BOPTA) was performed to define pulmonary arteries anatomy before PPVI. Wilcoxon and Pearson test was used.

The right ventricular end-diastolic volume index (RVEDVI, ml/m2) decreases significantly for PPVI and SPVR: from 81±37 to 68±16 (P=.030) and from 142 ± 34 to 88 ± 21 (P=.001) respectively. RV ejection fraction (RVEF, %) increased significantly in the SPVR group compared to the PPVI patients: from 46±11 to 53±9 (P=.038) and from 49 ±14 to 53 ±12 (P=.109) respectively. The left ventricular end-diastolic volume index (LVEDVI, ml/m2) increased more significantly after the procedure in the PPVI group, while changes were less evident and delayed in the SPVR patients: from 66±16 to 74±17 (P<.001) and from 61±7 to 66±12 (P=.055) respectively. Left ventricular stroke volume index (LVSVI, ml/m2) increased in both groups after PPVI and SPVR: from 38±12 to 41±11 (P=.004) and from 35±10 to 40±8 (P=.058) respectively. Finally there is an inverse correlation between the RV and LVEDVI (r=-0.014): as the RVEDVI decreased in the follow-up, the LVEDVI increased.

Alleviation of RVOT dysfunction is associated with reduction of RV volume and an improvement in global RV function, as well as positive effects on ventricular–ventricular interaction demonstrated by the increased LVSVI after the procedure.

Medium-term follow-up showed permanent beneficial effect of pulmonary valve replacement in both groups.

Secchi, F, Pluchinotta, F, Cannao, P, Butera, G, Lombardi, M, Sardanelli, F, Carminati, M, Medium-term Biventricular Heart Remodeling after Percutaneous and Surgical Pulmonary Valve Implantation: A Cardiac MR Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006816.html