Right ventricular remodelling after transcatheter pulmonary valve implantation.

Objectives: To define the optimal timing for percutaneous pulmonary valve implantation (PPVI) in patients with severe pulmonary regurgitation (PR) after Fallot's Tetralogy (ToF) correction. Background: PPVI among the aforementioned patients is mainly driven by symptoms or by severe right ventricular (RV) dilatation/dysfunction. The optimal timing for PPVI is still disputed. Methods: Twenty patients [age 13.9 +/- 9.2 years, (range 4.3-44.9), male 70%] with severe PR (>= 3 grade) secondary to previous correction of ToF, underwent Melody valve (Medtronic, Minneapolis, MN) implantation, after a pre-stent placement. Full echocardiographic assessment (traditional and deformation analysis) and cardiovascular magnetic resonance evaluation were performed before and at 3 months after the intervention. 'Favorable remodelling' was considered the upper quartile of RV size decrease (>20% in 3 months). Results: After PPVI, indexed RV effective stroke volume increased from 38.4 +/- 9.5 to 51.4 +/- 10.7 mL/m(2), (P=0.005), while RV end-diastolic volume and strain indices decreased (123.1 +/- 24.1-101.5 +/- 18.3 mL/m(2), P=0.005 and -23.5 +/- 2.5 to -21 +/- 2.5%, P=0.002, respectively). After inserting pre-PPVI clinical, RV volumetric and deformation parameters in a multiple regression model, only time after last surgical correction causing PR remained as significant regressor of RV remodelling [R-2=0.60, beta=0.387, 95% CI(0.07-0.7), P=0.019]. Volume reduction and functional improvement were more pronounced in patients treated with PPVI earlier than 7 years after last RV outflow tract (RVOT) correction, reaching close-to-normal values. Conclusions: Early PPVI (< 7 years after last RVOT operation) is associated with a more favorable RV reverse remodelling toward normal range and should be considered, before symptoms or RV damage become apparent. (C) 2017 Wiley Periodicals, Inc.