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Usefulness of maximal oxygen pulse in timing of pulmonary valve replacement in patients with isolated pulmonary regurgitation

Published online by Cambridge University Press:  22 December 2015

Antoine Legendre ,
Ruddy Richard ,
Florence Pontnau ,
Jean-Philippe Jais ,
Marc Dufour ,
Olivier Grenier ,
Elie Mousseaux ,
Magalie Ladouceur ,
Laurence Iserin  and
Damien Bonnet
Antoine Legendre*
Affiliation:
Pediatric Cardiology, Centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, Paris, France Adult Congenital Heart Disease Unit, Cardiology Department, Hôpital Européen Georges Pompidou, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Assistance Publique-Hôpitaux de Paris, Paris, France
Ruddy Richard
Affiliation:
Department of Sport Medicine and Functional Explorations, CHU Clermont-Ferrand and INRA UMR 1019, CRNH-Auvergne, Clermont-Ferrand, Paris, France
Florence Pontnau
Affiliation:
Adult Congenital Heart Disease Unit, Cardiology Department, Hôpital Européen Georges Pompidou, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Assistance Publique-Hôpitaux de Paris, Paris, France
Jean-Philippe Jais
Affiliation:
Paris-Descartes University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Assistance Publique-Hôpitaux de Paris, Necker hospital for sick children, Faculte de Medecine Necker Enfants Malades, Paris, France
Marc Dufour
Affiliation:
Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France; Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France
Olivier Grenier
Affiliation:
Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France; Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France
Elie Mousseaux
Affiliation:
Department of Cardiovascular Radiology, Hôpital Européen Georges Pompidou and INSERM U970, Paris-Descartes University, Paris Descartes University, Paris, France
Magalie Ladouceur
Affiliation:
Pediatric Cardiology, Centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, Paris, France Adult Congenital Heart Disease Unit, Cardiology Department, Hôpital Européen Georges Pompidou, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Assistance Publique-Hôpitaux de Paris, Paris, France
Laurence Iserin
Affiliation:
Adult Congenital Heart Disease Unit, Cardiology Department, Hôpital Européen Georges Pompidou, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Assistance Publique-Hôpitaux de Paris, Paris, France
Damien Bonnet
Affiliation:
Pediatric Cardiology, Centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
*
Correspondence to: A. Legendre, MD, Pediatric Cardiology, Centre de référence des Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, 149 rue de Sevres, 75743 Paris Cedex 15, France. Tel: +3 314 449 2599; Fax: +3 314 449 4340; E-mail: antoine.legendre@aphp.fr
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Abstract

Patients with pulmonary regurgitation after tetralogy of Fallot repair have impaired aerobic capacity; one of the reasons is the decreasing global ventricular performance at exercise, reflected by decreasing peak oxygen pulse. The aims of our study were to evaluate the impact of pulmonary valve replacement on peak oxygen pulse in a population with pure pulmonary regurgitation and with different degrees of right ventricular dilatation and to determine the predictors of peak oxygen pulse after pulmonary valve replacement.

The mean and median age at pulmonary valve replacement was 27 years. Mean pre-procedural right ventricular end-diastolic volume was 182 ml/m2. Out of 24 patients, 15 had abnormal peak oxygen pulse before pulmonary valve replacement. We did not observe a significant increase in peak oxygen pulse after pulmonary valve replacement (p=0.76). Among cardiopulmonary test/MRI/historical pre-procedural parameters, peak oxygen pulse appeared to be the best predictor of peak oxygen pulse after pulmonary valve replacement (positive and negative predictive values, respectively, 0.94 and 1). After pulmonary valve replacement, peak oxygen pulse was well correlated with left ventricular stroke and end-diastolic volumes (r=0.67 and 0.68, respectively).

Our study confirms the absence of an effect of pulmonary valve replacement on peak oxygen pulse whatever the initial right ventricular volume, reflecting possible irreversible right and/or left ventricle lesions. Pre-procedural peak oxygen pulse seemed to well predict post-procedural peak oxygen pulse. These results encourage discussions on pulmonary valve replacement in patients showing any decrease in peak oxygen pulse during their follow-up.

Keywords

CHDpulmonary valve replacementcardiopulmonary exercise testoxygen pulse
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1310 - 1318
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Copyright
© Cambridge University Press 2015 

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