Evaluation of Peak Pressure Gradients in Patients after Melody Valve Implantation: A Comparison of Cardiac Catheterization and Doppler Echocardiography. Issue 7 (1st November 2014)

• Record Type: Journal Article
• Authors: Bauer, Brenton S.; Zachariah, Sybil; Levi, Daniel; Rothman, Abraham; Galindo, Alvaro; Aboulhosn, Jamil A
• Is Part Of: Echocardiography. Volume 32:Issue 7(2015:Jul.)
• Page Start: 1073
• Page End: 1079
• Publication Date: 2014-11-01
• Subjects: Echocardiography -- Periodicals; Echocardiography -- Periodicals; 616.1207543
• DOI: 10.1111/echo.12827
• Languages: English
• ISSNs: 0742-2822

Abstract

<abstract abstract-type="main" id="echo12827-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="echo12827-sec-0001" sec-type="section"> <title>Objectives</title> <p>The aim of this study was to determine and quantify the relationship between Doppler echocardiography and cardiac catheterization measurements of the peak right ventricle‐pulmonary artery (RV‐PA) pressure gradient in patients within 24 hours of Melody valve implantation for treatment of a dysfunctional RV outflow tract (RVOT) conduit or bioprosthetic valve (BPV).</p> </sec> <sec id="echo12827-sec-0002" sec-type="section"> <title>Background</title> <p>Patients with a dysfunctional RVOT conduit or BPV are now routinely treated percutaneously with implantation of a Melody valve. However, often the postimplantation catheter measurements of the RV‐PA peak gradient do not match the postimplant echo‐derived gradients obtained after completion of the procedure. Importantly, these echo gradients are commonly used to monitor patients after implantation over time.</p> </sec> <sec id="echo12827-sec-0003" sec-type="section"> <title>Methods</title> <p>Medical records of 42 patients with Melody valve implantation were reviewed (men: 25/42; mean age: 22.4 ± 11.2 years; RVOT conduit: 23/42; BPV: 18/42; pulmonic stenosis: 6/42, pulmonic regurgitation: 3/42, both: 33/42).</p> </sec> <sec id="echo12827-sec-0004" sec-type="section"> <title>Results</title> <p>The postimplantation RV‐PA peak gradient measured by Doppler echocardiography (within 24 hours of valve implantation) was significantly higher than the measurements acquired by catheterization immediately following implantation (24.2 ± 16.3 mmHg vs. 11.6 ± 8.5 mmHg, P < 0.0001). The relationship showed a moderate–strong correlation (r = 0.65, P < 0.0001) with regression analysis suggesting a linear association in both directions (echo gradient = 1.24 × cath gradient + 9.8, P<0.0001 vs. cath gradient = 0.34 × echo gradient + 3.4, P<0.0001).</p> </sec> <sec id="echo12827-sec-0005" sec-type="section"> <title>Conclusion</title> <p>The Doppler echocardiography‐derived RV‐PA peak gradient within 24 hours of valve implantation is predictably higher than the catheter measured peak gradient immediately following valve implantation. A regression equation was derived to define this important relationship.</p> </sec> </abstract>