Assessment of Right Ventricular Reverse Remodeling in Infants with Critical Pulmonary Stenosis after Balloon Pulmonary Valvuloplasty Using 3D Echocardiography
Authors: Zidane Mostafa , Nour Amira , Adel Dina , ElShahed Ghada 
Published: August 2023

Abstract

Aim and Objectives
The aim of this study is to identify role of 3D echocardiographic assessment of RV volumes and function in infants with critical pulmonary stenosis undergoing balloon pulmonary valvuloplasty pre and post dilatation, the immediate and intermediate term outcome of relieving obstruction on RV volumes

Patients and Methods
The study included all infants who were referred for elective or urgent BPV in the congenital and structural heart disease Unit, Cardiology department, Ain Shams University because of critical pulmonary stenosis and are followed for 3-6 months after the procedure since first of December 2020 till end of august 2021.

Results
sixty infants with critical PS with a median age of 8.5 months were subjected to BPV, immediately after the procedure there was significant reduction in RVSP (P &lt; 0.01), there was significant increase in TAPSE, Annulus and FAC by 2D echocardiography immediately post procedure and at 3-6 month follow up (P &lt; 0.01), while there was significant decrease in PG immediately post procedure and throughout a follow up period of 3-6 month (P &lt; 0.01), The indexed RV wall thickness and indexed RA area showed no significant change between pre and immediately post procedure while there was significant decrease at 3-6 month than pre and immediately post (P &lt; 0.01), The indexed End-Diastolic and End systolic volumes by 3D Echocardiography decreased insignificantly immediately post procedure (P = 0.421) (P = 0.317) respectively while it decreased significantly at 3-6 month follow up (P &lt; 0.05), The right ventricle Ejection fraction, FAC and TAPSE by 3D echocardiography increased significantly immediately post procedure and throughout a follow up period of 3-6 month (P &lt; 0.01), The Basal RV dimension by 3D echocardiography decreased insignificantly immediately post procedure (P = 0.057)while there was significant decrease at 3-6 month than pre and immediately post (P &lt; 0.01), The mid RV dimension and Longitudinal RV dimension by 3D Echocardiography decreased significantly immediately post procedure and at 3-6 month follow up (P &lt; 0.01).

Conclusion
BPV is safe and effective to relieve critical PS. The balloon promotes advantageous changes in pulmonary annulus RVSP, PG and FAC by two dimensional echo across the RVOT. In addition, the Doppler gradient observations during the follow-up support the expectation that BPV is a ‘curative’ therapy and Three-dimensional echocardiography is an effective method to assess RV volumes and function

Abbreviations
RV: Right ventricle; CHD: Congenital heart disease; BPV: Balloon pulmonary valvuloplasty; LV: Left ventricle; PS: Pulmonary stenosis; HF: Heart failure; RVSP: Right ventricle systolic pressure; ASD: Atrial septal defect; TAPSE: Tricuspid annular peak systolic excursion; PFO: patent foramen ovale; FAC: Fractional area change; VSD: Ventricular septal defect; PG: Pressure gradient; PDA: patent ductus arterioses; RA: Right atrium; RVES: Right ventricle end systole; RVOT: Right ventricle outflow tract; RVED: Right ventricle end diastole; CMR: Cardiac magnetic resonance