Document Type

Article

Publication Date

8-1-2013

Identifier

PMCID: PMC3817561 DOI: 10.1111/echo.12147

Abstract

OBJECTIVES: To evaluate echocardiographic changes after SAPIEN valve implantation in the pulmonary position.

BACKGROUND: The feasibility of the SAPIEN transcatheter pulmonary valve (TPV) has recently been demonstrated. We evaluated changes in pulmonary valve function and the right ventricle after SAPIEN TPV placement.

METHODS: We evaluated echocardiograms at baseline, discharge, 1 and 6 months after TPV placement in 33 patients from 4 centers. Pulmonary insufficiency severity was graded 0-4. TPV peak and mean gradients were measured. Right ventricular (RV) size and function were quantified using routine measures derived from color, spectral, and tissue Doppler indices and two-dimensional echocardiography.

RESULTS: At baseline, 94% patients demonstrated pulmonary insufficiency grade 2-4. This decreased to 12% patients at 6 months (P < 0.01). TPV peak (P < 0.01) and mean gradient (P < 0.01) decreased. RV end-diastolic area indexed to body surface area (BSA) (P < 0.01), Tricuspid regurgitation (TR) gradient (P < 0.01), and the ratio of TR jet area to BSA (P < 0.01) decreased. Tricuspid inflow peak E:A, tissue Doppler imaging (TDI): septal E' and A', TDI: tricuspid A' improved between baseline and discharge, but trended back to baseline by 6-month follow-up. Tricuspid valve annulus z-score, RV area change, tricuspid annular plane systolic excursion (TAPSE), RV dP/dt, tricuspid E:E', and TDI: tricuspid annulus E' showed no change.

CONCLUSION: Improvements in pulmonary insufficiency and stenosis, RV size, and TR gradient and severity are seen after SAPIEN TPV placement. Selected indices of RV diastolic function improve immediately after TPV implantation, but return to baseline by 6 months. RV systolic function is unchanged.

Journal Title

Echocardiography (Mount Kisco, N.Y.)

Volume

30

Issue

7

First Page

786

Last Page

793

MeSH Keywords

Adult; Cardiac Catheters; Echocardiography; Equipment Failure Analysis; Feasibility Studies; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Prosthesis Design; Pulmonary Valve; Pulmonary Valve Insufficiency; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome; United States

Keywords

congenital heart disease; echocardiography; percutaneous intervention; pulmonary regurgitation; pulmonary valve; right ventricle

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