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Preprocedural Risk Assessment Prior to PPVI with CMR and Cardiac CT

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An Erratum to this article was published on 07 June 2017

Abstract

Percutaneous pulmonary valve intervention (PPVI) is a less invasive and less costly approach to pulmonary valve replacement compared with the surgical alternative. Potential complications of PPVI include coronary compression and pulmonary arterial injury/rupture. The purpose of this study was to characterize the morphological risk factors for PPVI complication with cardiac MRI and cardiac CTA. A retrospective review of 88 PPVI procedures was performed. 44 patients had preprocedural cardiac MRIs or CTAs available for review. Multiple morphological variables on cardiac MRI and CTA were compared with known PPVI outcome and used to investigate associations of variables in determining coronary compression or right ventricular–pulmonary arterial conduit injury. The most significant risk factor for coronary artery compression was the proximity of the coronary arteries to the conduit. In all patients with coronary compression during PPVI, the coronary artery touched the conduit on the preprocedural CTA/MRI, whilst in patients without coronary compression the mean distance between the coronary artery and the conduit was 4.9 mm (range of 0.8–20 mm). Multivariable regression analysis demonstrated that exuberant conduit calcification was the most important variable for determining conduit injury. Position of the coronary artery directly contacting the conduit without any intervening fat may predict coronary artery compression during PPVI. Exuberant conduit calcification increases the risk of PPVI-associated conduit injury. Close attention to these factors is recommended prior to intervention in patients with pulmonary valve dysfunction.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital Colorado, Aurora, Colorado, USA

    Ladonna Malone & Lorna P. Browne

  2. Department of Cardiology, Children’s Hospital Colorado, Aurora, Colorado, USA

    Brian Fonseca, Neil Wilson, Micheal DiMaria & Uyen Truong

  3. University of Tennessee Health Sciences Center, Aurora, Colorado, USA

    Thomas Fagan

  4. Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA

    Jane Gralla

Authors
  1. Ladonna Malone
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  2. Brian Fonseca
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  3. Thomas Fagan
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  4. Jane Gralla
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  5. Neil Wilson
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  6. Micheal DiMaria
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  7. Uyen Truong
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  8. Lorna P. Browne
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Correspondence to Lorna P. Browne.

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The authors declare that they have no potential conflict of interest.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00246-017-1643-4.

Appendix

Appendix

See Table 6.

Table 6 Typical cardiac MRI sequence parameters
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Malone, L., Fonseca, B., Fagan, T. et al. Preprocedural Risk Assessment Prior to PPVI with CMR and Cardiac CT. Pediatr Cardiol 38, 746–753 (2017). https://doi.org/10.1007/s00246-017-1574-0

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  • DOI: https://doi.org/10.1007/s00246-017-1574-0

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