Longitudinal function and ventricular dyssynchrony are restored in children with pulmonary stenosis after percutaneous balloon pulmonary valvuloplasty

Abstract

The aim of this study was to evaluate the impact of balloon pulmonary valvuloplasty on longitudinal ventricular dysfunction and cardiac dyssynchrony in children with congenital moderately severe pulmonary stenosis (PS). Forty-eight children with congenital moderately severe valvular pulmonary stenosis and 36 age-matched normal children were included. Successful percutaneous balloon pulmonary valvuloplasty was performed for children with PS. Longitudinal Cardiac function and myocardial synchrony was assessed by echocardiography with tissue Doppler imaging (TDI). Mitral annular plane excursion (MAPSE), tricuspid annular plane excursion (TAPSE), left ventricular systolic wave (LVs), right ventricular systolic wave (RVs) and myocardial synchrony was assessed by echocardiography with TDI. TAPSE, RVs, TAPSE/MAPSE ratio and RVs/LVs ratio were significantly lower in children with PS compared to control subjects: (P < 0.001, P < 0.001, P < 0.001 and P < 0.001). All these parameters were significantly improved after balloon valvuloplasty in children with PS. Intra& inter-ventricular dyssynchrony were significantly increased in PS patients than in control group, (P < 0.03, <0.001 and 0.02 respectively). All these variables were significantly reduced after pulmonary valvuloplasty. In children with valvular PS, balloon valvuloplasty restored longitudinal function and cardiac Synchrony. This gives good insights for the importance of early intervention in children with PS to prevent the progression for cardiac deformation.

Right ventricular function in infants with bronchopulmonary dysplasia and pulmonary hypertension: a pilot study

“…34 In contrast, increased afterload of the RV in the setting of congenital pulmonary valve stenosis is associated with normal systolic function as assessed by RV FAC, possibly because in early infancy the RV is used to the physiological high PVR and high PAP and can therefore maintain adequate RV function. 35,36 Interestingly, in our study, RV size as assessed by tricuspid valve annulus size or RV dimension in diastole were similar between children with and without PH. Our data, together with the data by Levy et al., 14,32 suggest that adaptation of the RV in extremely premature-born children with BPD and PH is fundamentally different as compared to older children or adults with IPAH (decreased RV function and RV dilatation) as well as infants and children with pulmonary valve stenosis (relatively well-preserved RV function).…”

“…In addition, the RV is dilated in adult patients with IPAH and increased RV volume strongly predicts mortality in these patients 34 . In contrast, increased afterload of the RV in the setting of congenital pulmonary valve stenosis is associated with normal systolic function as assessed by RV FAC, possibly because in early infancy the RV is used to the physiological high PVR and high PAP and can therefore maintain adequate RV function 35 , 36 . Interestingly, in our study, RV size as assessed by tricuspid valve annulus size or RV dimension in diastole were similar between children with and without PH.…”

Color tissue doppler imaging of tricuspid annular plane systolic and diastolic excursion in children: A comparison of normal, volume‐overloaded and pressure overloaded right ventricles

“…They reported decreased TAPSE (15.2 ± 3.2 vs. 24.1 ± 2.9, P < .001) and reduced peak systolic velocity of RV free wall (9.3 ± 2.3 vs. 14.5 ± 2.5, P < .001) before the procedure and restoration to normal after the pulmonary valvuloplasty. 35 Their and others' findings are consistent with our results. 36 Agac et al compared RV function in twenty patients, aged 37 ± 16 years, with secundum ASD before and one month after transcatheter closure.…”

Intraobserver and interobserver reproducibility of M-mode and B-mode acquired mitral annular plane systolic excursion (MAPSE) and its dependency on echocardiographic image quality in children

“…For instance, in children with acute-phase Kawasaki disease MAPSE z-scores beyond a cutoff value of -0.9 served as an indicator to detect LV dysfunction [ 18 ]. Furthermore, MAPSE was shown to be depressed in children with pulmonary stenosis and restored after percutaneous balloon pulmonary valvuloplasty [ 19 ]. Another clinical implication is the early detection of ventricular dysfunction in pediatric oncology patients following anthracycline chemotherapy [ 20 ].…”