Percutaneous pulmonary valve implantation (PPVI) with self-expanding devices such as the Venus P-valve has expanded treatment options for patients with large ventricular outflow tracts (RVOT). However, the impact of PPVI on right ventricular (RV) pulmonary arterial coupling remains incompletely understood. The TAPSE/PAPS ratio has emerged as a simple, non-invasive surrogate of RV coupling and may provide insights into RV adaptation following intervention.

We conducted a longitudinal analysis of 77 patients undergoing PPVI with the Venus P-valve, evaluating echocardiographic parameters at three time points: baseline (T0), early post-procedural (T1), and 6-month follow-up (T2). Key parameters included tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PAPS), and the TAPSE/PAPS ratio. Paired comparisons between time points were performed to assess temporal changes.

Of the 77 patients (mean age: 39.9 ± 14.7 years), 45 were male, and 52 had Tetralogy of Fallot. After the PPVI a significant reduction in TAPSE was observed (T0 vs T1: −2.6 mm; P < 0.001), which persisted at 6 months (T0 vs T2: −3.2 mm; P < 0.001), with no further significant change between T1 and T2 ( P = 0.215). Conversely, PAPS showed a significant decrease both acutely (−3.5 mmHg; P = 0.007) and over time (T1 vs T2: −1.8 mmHg; P = 0.011), resulting in an overall reduction of −5.3 mmHg at follow-up ( P < 0.001). Despite these changes, the TAPSE/PAPS ratio remained stable across all time points (T0 vs T1: P = 0.482; T0 vs T2: P = 0.741), with a non-significant trend toward improvement at 6 months ( P = 0.064).

PPVI with the Venus P-valve is associated with acute RV unloading, reflected by a reduction in TAPSE, and a progressive decrease in pulmonary pressures. The preservation of the TAPSE/PAPS ratio suggests maintained RV–pulmonary arterial coupling despite changes in individual parameters. These findings support the concept of adaptive RV remodeling following PPVI and highlight the relevance of coupling indices in the longitudinal assessment of RV function.