TY - JOUR
T1 - Carcinoid heart disease
T2 - Impact of pulmonary valve replacement in right ventricular function and remodeling
AU - Connolly, Heidi M.
AU - Schaff, Hartzell V.
AU - Mullany, Charles J.
AU - Abel, Martin D.
AU - Pellikka, Patricia A.
PY - 2002/9/24
Y1 - 2002/9/24
N2 - Background - Carcinoid heart disease characteristically affects tricuspid (TV) and pulmonary valves (PV), and TV replacement is helpful in selected patients. There is uncertainty, however, regarding optimal surgical management of PV regurgitation. Methods and Results - We reviewed 22 patients having operation for carcinoid heart disease and compared those having TV and PV replacement (n = 12), to those who underwent TV replacement and excision of the PV (n = 10). Pre- and postoperative right ventricular (RV) size and dysfunction were assessed by consensus of 2 echocardiographers blinded to type of surgical treatment. RV dysfunction was graded as none (0), mild (1), moderate (2), or severe (3). RV size was graded as normal (0), or mild (1), moderate (2), or severe (3) enlargement. Preoperatively, RV size (2.2±0.8 [no PVR]versus 2.7±0.6 [with PVR], P=0.15), RV dysfunction (0.9±0.9 [no PVR]versus 1.4±0.7 [with PVR], P=0.14), and NYHA class were similar in the 2 groups. Postop RV size decreased inpatients with PVR, 2.7±0.6 to 1.7±1.0 (P=0.008), but did not change appreciably in those without PVR, 2.2±0.8 to 2.3±0.8 (P=0.67). There was no significant change in RV dysfunction after surgery, 1.4±0.7 to 1.8±0.9 with PVR (P=0.26) and 0.9±0.9 to 1.6±0.9 without PVR (P=0.07). Conclusions - PV replacement appears to have a beneficial effect on RV size in patients after surgery for carcinoid heart disease. This may have important implications for RV remodeling after PV replacement.
AB - Background - Carcinoid heart disease characteristically affects tricuspid (TV) and pulmonary valves (PV), and TV replacement is helpful in selected patients. There is uncertainty, however, regarding optimal surgical management of PV regurgitation. Methods and Results - We reviewed 22 patients having operation for carcinoid heart disease and compared those having TV and PV replacement (n = 12), to those who underwent TV replacement and excision of the PV (n = 10). Pre- and postoperative right ventricular (RV) size and dysfunction were assessed by consensus of 2 echocardiographers blinded to type of surgical treatment. RV dysfunction was graded as none (0), mild (1), moderate (2), or severe (3). RV size was graded as normal (0), or mild (1), moderate (2), or severe (3) enlargement. Preoperatively, RV size (2.2±0.8 [no PVR]versus 2.7±0.6 [with PVR], P=0.15), RV dysfunction (0.9±0.9 [no PVR]versus 1.4±0.7 [with PVR], P=0.14), and NYHA class were similar in the 2 groups. Postop RV size decreased inpatients with PVR, 2.7±0.6 to 1.7±1.0 (P=0.008), but did not change appreciably in those without PVR, 2.2±0.8 to 2.3±0.8 (P=0.67). There was no significant change in RV dysfunction after surgery, 1.4±0.7 to 1.8±0.9 with PVR (P=0.26) and 0.9±0.9 to 1.6±0.9 without PVR (P=0.07). Conclusions - PV replacement appears to have a beneficial effect on RV size in patients after surgery for carcinoid heart disease. This may have important implications for RV remodeling after PV replacement.
KW - Carcinoid
KW - Regurgitation
KW - Surgery
KW - Valves
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M3 - Article
C2 - 12354709
AN - SCOPUS:0037167644
SN - 0009-7322
VL - 106
SP - I51-I56
JO - Circulation
JF - Circulation
IS - 13 SUPPL.
ER -