PDF(Pubmed)
Abstract：
BACKGROUND: There are limited data about the impact of timing of pulmonary valve replacement (PVR) on right heart reverse remodeling in patients with pulmonary regurgitation following intervention for isolated pulmonary valve stenosis (PS). This study compared differences in postprocedural right heart reverse remodeling after early versus late PVR (defined as PVR before versus after attainment of the conservative consensus criteria proposed by Bokma et al, 2018) in patients with prior intervention for PS, using patients with tetralogy of Fallot as the reference group.
RESULTS: Right atrial reservoir strain and right ventricular free wall strain was measured at baseline, 1 and 3 years after PVR. There were 114 patients with PS (early PVR, 87 [76%]; late PVR, 27 [24%]) and 291 patients with tetralogy of Fallot (early PVR, 197 [67%]; late PVR, 96 [33%]). The PS group had greater improvement in right atrial reservoir strain at 1 year (12%±4% versus 8%±4%; P<0.001) and 3 years (15%±6% versus 9%±6%; P<0.001), and a greater improvement in right ventricular free wall strain at 1 year (12%±4% versus 7%±3%, P=0.008) and 3-years (16%±6% versus 12%±5%; P=0.01) after PVR compared with the tetralogy of Fallot group. There was no difference in right heart reverse remodeling between patients who underwent early versus later PVR within the PS group. In contrast, late PVR was associated with less right heart reverse remodeling within the tetralogy of Fallot group.
CONCLUSIONS: These data suggest that patients with palliated PS presenting pulmonary regurgitation have a more benign clinical course, and hence delaying PVR in this population may be appropriate.
RESULTS: Right atrial reservoir strain and right ventricular free wall strain was measured at baseline, 1 and 3 years after PVR. There were 114 patients with PS (early PVR, 87 [76%]; late PVR, 27 [24%]) and 291 patients with tetralogy of Fallot (early PVR, 197 [67%]; late PVR, 96 [33%]). The PS group had greater improvement in right atrial reservoir strain at 1 year (12%±4% versus 8%±4%; P<0.001) and 3 years (15%±6% versus 9%±6%; P<0.001), and a greater improvement in right ventricular free wall strain at 1 year (12%±4% versus 7%±3%, P=0.008) and 3-years (16%±6% versus 12%±5%; P=0.01) after PVR compared with the tetralogy of Fallot group. There was no difference in right heart reverse remodeling between patients who underwent early versus later PVR within the PS group. In contrast, late PVR was associated with less right heart reverse remodeling within the tetralogy of Fallot group.
CONCLUSIONS: These data suggest that patients with palliated PS presenting pulmonary regurgitation have a more benign clinical course, and hence delaying PVR in this population may be appropriate.
摘要：
背景：关于肺动脉瓣置换术（PVR）时机对孤立性肺动脉瓣狭窄（PS）介入治疗后肺动脉瓣返流患者右心逆向重构的影响的数据有限。本研究比较了早期与晚期PVR术后右心逆重构的差异（定义为达到Bokma等人提出的保守共识标准之前与之后的PVR，2018)在先前接受过PS干预的患者中，以法洛四联症患者为参照组。
结果：在基线测量右心房储库应变和右心室游离壁应变，PVR后1年和3年。有114例PS（早期PVR，87[76%]；晚期PVR，27[24%]）和291例法洛四联症患者（早期PVR，197[67%]；晚期PVR，96[33%]）。PS组在1年（12％±4％对8％±4％；P<0.001）和3年（15％±6％对9％±6％；P<0.001）时，右心房储库应变的改善更大，1年时右心室游离壁应变有更大的改善(12%±4%对7%±3%,与法洛四联症组相比，PVR后P=0.008）和3年（16％±6％对12％±5％；P=0.01）。在PS组中，早期和晚期PVR患者的右心脏逆向重塑没有差异。相比之下,晚期PVR与法洛四联症组右心逆转重构较少相关.
结论：这些数据表明，出现肺返流的缓解性PS患者的临床病程更为良性，因此延迟该人群的PVR可能是合适的。
结果：在基线测量右心房储库应变和右心室游离壁应变，PVR后1年和3年。有114例PS（早期PVR，87[76%]；晚期PVR，27[24%]）和291例法洛四联症患者（早期PVR，197[67%]；晚期PVR，96[33%]）。PS组在1年（12％±4％对8％±4％；P<0.001）和3年（15％±6％对9％±6％；P<0.001）时，右心房储库应变的改善更大，1年时右心室游离壁应变有更大的改善(12%±4%对7%±3%,与法洛四联症组相比，PVR后P=0.008）和3年（16％±6％对12％±5％；P=0.01）。在PS组中，早期和晚期PVR患者的右心脏逆向重塑没有差异。相比之下,晚期PVR与法洛四联症组右心逆转重构较少相关.
结论：这些数据表明，出现肺返流的缓解性PS患者的临床病程更为良性，因此延迟该人群的PVR可能是合适的。
