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Transcatheter Pulmonary Valve Replacement and Acute Increase in Diastolic Pressure are Associated with Increases in Both Systolic and Diastolic Pulmonary Artery Dimensions

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Abstract

Stable positioning of a transcatheter pulmonary valve (TPV) in native outflow tracts depends on a clear understanding of underlying anatomy and outflow tract dimensions. We hypothesized that restoration of pulmonary competence may acutely alter these dimensions. A retrospective single-center review of consecutive patients after TPV placement from 2007 to 2014 was performed. Patients with less than moderate pulmonary regurgitation were excluded. We reviewed acute catheterization data on 46 patients, most with tetralogy of Fallot (70%). Baseline and post-implant (7.5 ± 3 min post-deployment) measurements of central pulmonary arteries (PAs) were determined angiographically. The right PA diameter increased (20 ± 4–24 ± 6 mm systole*, 16 ± 4–21 ± 6 mm diastole*), as did the left PA (20 ± 6–24 ± 8 mm systole*, 16 ± 5–21 ± 7 mm diastole*). PA pressures increased from averages of 29.3/10.6 (17) to 29.8/15.1 (21) mmHg. We noted that pre-implant systolic PA diameter correlated with diastolic PA diameter post-implant (r = 0.9). On follow-up catheterization in seven patients [median 3 years; (1–8)], combined central PA diameter decreased an average of 20% (systole: 20% ± 12, diastole: 18% ± 11) as compared to post-implant measurements. Acute pulmonary valve competence in patients with at least moderate pulmonary regurgitation results in an immediate increase in PA diameter (20% systole and 30% diastole). The cause of this diameter change is unclear. This acute change may have implications for device and patient selection (*p < 0.001).

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Authors and Affiliations

  1. Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, USA

    Ryan Callahan, Lisa Bergersen, James E. Lock & Audrey C. Marshall

  2. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Ryan Callahan, Lisa Bergersen, James E. Lock & Audrey C. Marshall

Authors
  1. Ryan Callahan
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  2. Lisa Bergersen
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  3. James E. Lock
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  4. Audrey C. Marshall
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Correspondence to Ryan Callahan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

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Callahan, R., Bergersen, L., Lock, J.E. et al. Transcatheter Pulmonary Valve Replacement and Acute Increase in Diastolic Pressure are Associated with Increases in Both Systolic and Diastolic Pulmonary Artery Dimensions. Pediatr Cardiol 38, 456–464 (2017). https://doi.org/10.1007/s00246-016-1535-z

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  • DOI: https://doi.org/10.1007/s00246-016-1535-z

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