Exercise capacity and ventricular function in patients treated for isolated pulmonary valve stenosis or tetralogy of Fallot

• Published in: International journal of cardiology 2012-07, Vol.158 (3), p.359-363
• Main Authors: Luijnenburg, Saskia E, de Koning, Wilfred B, Romeih, Soha, van den Berg, Jochem, Vliegen, Hubert W, Mulder, Barbara J.M, Helbing, Willem A
• Format: Article
• Language: English
• Subjects: Adolescent; Balloon pulmonary valvuloplasty; Balloon Valvuloplasty; Biological and medical sciences; Cardiology. Vascular system; Cardiopulmonary exercise testing; Cardiovascular; Cardiovascular magnetic resonance imaging; Child; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Electrocardiography; Exercise Test; Exercise Tolerance - physiology; Female; Follow-Up Studies; Heart; Humans; Hypertrophy, Right Ventricular - physiopathology; Isolated pulmonary valve stenosis; Magnetic Resonance Imaging; Male; Medical sciences; Oxygen Consumption - physiology; Pulmonary Valve Stenosis - physiopathology; Pulmonary Valve Stenosis - surgery; Tetralogy of Fallot; Tetralogy of Fallot - physiopathology; Tetralogy of Fallot - surgery; Treatment Outcome; Ventricular Function, Right - physiology; Young Adult
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2011.01.038

Abstract Background We hypothesized 1) that long-term ventricular outcome and exercise capacity would be better in patients with isolated pulmonary valve stenosis (PS) treated with balloon pulmonary valvuloplasty (BPV) than in patients operated for tetralogy of Fallot (TOF), and 2) that ventricular outcome and exercise capacity would not be different in PS patients and healthy controls. Methods We included 21 PS patients after BPV (16.2 ± 5.2 years) and 21 patients operated for TOF (16.6 ± 5.6 years), matching them for gender, age at treatment, and age at study. Patients underwent cardiovascular magnetic resonance (CMR) imaging, exercise testing, 12-lead ECG and 24-hour Holter monitoring for assessment of right ventricular (RV) size and function, pulmonary regurgitation (PR), exercise capacity and electrocardiographic status. Healthy controls for CMR imaging and exercise testing were matched for gender and age at study. Results RV volumes and PR percentage were significantly larger in TOF patients than in PS patients; biventricular ejection fraction (EF) was not different. PR was mild in most PS patients. RV end-systolic volume was significantly larger in PS patients than in healthy controls; RVEF was significantly lower. Both patient groups had similar exercise test results. Peak workload and VO2 max. were significantly lower in PS patients than in healthy controls. Conclusions Longstanding mild PR in PS patients can lead to an enlarged RV, reduced RV function and reduced exercise capacity. Despite more PR and larger RV volumes in TOF patients, exercise capacity and biventricular function are similar in both patient groups.