Percutaneous Pulmonary Valve Implantation

In this issue of Circulation: Cardiovascular Interventions , Borik et al1 review the intermediate and long-term echocardiographic, MRI and cardiopulmonary exercise results in a cohort of 51 patients followed for a mean of 4.5±1.9 (0.9–6.9) years after percutaneous pulmonary valve implantation (PPVI). The majority of patients had mixed pulmonary stenosis (PS) and pulmonary regurgitation (PR; 32/51) or predominant PS (16/51). The cohort is divided into patients 16 years. Clinical outcomes are favorable in the overall cohort, no differences were noted in the need for reintervention or reoperation between the younger and older groups and there was only one episode of endocarditis. Incremental improvements in right ventricular size by echo and MRI were noted in younger patients and there was a trend toward improvement in right ventricular ejection fraction in patients u003c16 years of age. Moreover, the authors noted greater improvement in maximum oxygen consumption in younger patients, those with lower preimplantation right-sided pressures, and those with better ventricular function and aerobic capacity before implantation. The improvements in aerobic capacity occurred within the first year and plateaued thereafter. The authors concluded that PPVI in younger patients with right ventricular outflow tract (RVOT) dysfunction is associated with improved aerobic exercise capacity and right ventricular dimensions.See Article by Borik et al There is general consensus among experts in congenital heart disease that symptomatic patients with RVOT dysfunction should undergo pulmonary valve replacement.2 Symptomatic patients include those with decreased functional capacity, evidence of heart failure, and arrhythmias. The timing of pulmonary valve replacement in asymptomatic patients with RVOT dysfunction is more controversial. Coats et al3 demonstrated that patients with RVOT obstruction, defined as an echo Doppler-derived peak systolic gradient ≥50 mm Hg, benefited from PPVI with resultant immediate reductions …