Schievano, S; Coats, L; Migliavacca, F; Norman, W; Frigiola, A; Deanfield, J; Bonhoeffer, P; Schievano, S; Coats, L; Migliavacca, F; Norman, W; Frigiola, A; Deanfield, J; Bonhoeffer, P; Taylor, AM; - view fewer (2007) Variations in right ventricular outflow tract morphology following repair of congenital heart disease: Implications for percutaneous pulmonary valve implantation. Journal of Cardiovascular Magnetic Resonance , 9 (4) 687 - 695. 10.1080/10976640601187596.

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Abstract

Objective: Our aim was to identify sub-groups of right ventricular outflow tract morphology that would be suitable for percutaneous pulmonary valve implantation and to document their prevalence in our patient population. Materials and Methods: Eighty-three consecutive patients with right ventricular outflow tract dysfunction (5-41 years, 76% tetralogy of Fallot) referred to our center for cardiovascular magnetic resonance were studied. A morphological classification was created according to visual assessment of three-dimensional reconstructions and detailed measurement. Diagnosis, right ventricular outflow tract type, surgical history and treatment outcomes were documented. Results: Right ventricular outflow tract morphology was heterogeneous; nevertheless, 5 patterns were visually identified. Type I, a pyramidal morphology, was most prevalent (49%) and related to the presence of a transannular patch. Other types (II-V) were seen more commonly in patients with conduits. Two patients had unclassifiable morphology. Ninety-five percent of patients were assigned to the correct morphological classification by visual assessment alone. Percutaneous pulmonary valve implantation was performed successfully in 10 patients with Type II-V morphology and in 1 patient with unclassifiable morphology. Percutaneous implantation was not performed in patients with Type I morphology. Only right ventricular outflow tract diameters < 22mmin diameter were suitable for the current device. Conclusions: We have created a morphological classification of the RVOT in patients referred for assessment of RVOT dysfunction. Though only 13% of our patients underwent percutaneous implantation, > 50% of outflow tract morphologies may be suitable for this approach, in particular with the development of new devices appropriate for larger outflow.

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