Background: In patients with RVOT stenosis and/or pulmonary regurgitation, percutaneous pulmonary
valve implantation (PPVI) aims to preserve right (RV) and left (LV) ventricular integrity
and function. Our study thought to assess acute changes in biventricular intrinsic
myocardial function occurring with PPVI.
Methods: Twenty patients with RVOT dysfunction (age 23.0 ± 10.9 years, 9 females, mean peak
echocardiographic RVOT gradient 64 ± 25 mm Hg) underwent PPVI with biventricular assessment
of pressure–volume loops using conductance catheter technique during the same catheterization.
Load-independent parameters of systolic (Ees) and diastolic (Eed) function as well
as pulmonary/systemic arterial elastance (Ea) and V–A coupling (Ea/Ees) were assessed
before and directly after PPVI. Cardiac magnetic resonance (CMR) for quantification
of biventricular volumes, function and pulmonary regurgitation (PR) was also performed.
Results: After PPVI, both RV Ees (p = 0.036) and pulmonary Ea (p = 0.0002) decreased significantly while right V–A coupling (p = 0.76) remained impaired. LV Ees (p = 0.68) and left V–A coupling (p = 0.98) were not affected by PPVI although systemic Ea increased significantly (p = 0.03). Both RV (p = 0.37) and LV (p = 0.20) Eed showed no significant change with PPVI. Patients with relevant PR (≥25%,
n = 10) had lower RV Ees (p = 0.03) before and higher LV Eed (p = 0.01) after PPVI as compared with patients with minor PR (<25%, n = 10) whereas V-A coupling was similar between the two groups.
Conclusion: Acute unloading of the RV by PPVI is accompanied by an instantaneous decline in RV
contractility with persistent abnormal V-A coupling. The LV adequately adapts to an
increase in pre- and afterload with unchanged LV intrinsic function and V–A coupling.
The relevance of these response patterns on long-term biventricular remodeling require
further investigation.
