Author + information
- Allison C. Hill,
- Steven Colan,
- David Brown,
- Kimberlee Gauvreau,
- Pedro del Nido,
- James Lock and
- Rahul Rathod
The natural history and results of surgical intervention in mixed aortic valve disease (MAVD) in children are unknown. We hypothesized that surgery for MAVD would improve valve function, decrease left ventricular end diastolic volume (LV EDV), decrease LV mass, and preserve systolic function.
Clinical and testing data for 90 patients with at least both moderate aortic stenosis and aortic regurgitation were analyzed retrospectively. A novel MAVD score (= aortic valve gradient * LV EDV z-score) was created.
Half had been managed medically and half had aortic valve surgery, with median age for surgery at 13 years. LV EDV and mass were elevated in both groups (LV EDV z-scores 2.5 ± 1.6 and 3.5 ± 2.5 respectively; LV mass z-scores 3.4 ± 1.9 and 4.2 ± 2.1 respectively). LV mass volume ratio (MVR) and ejection fraction were normal in both groups. Early diastolic pulsed-Doppler mitral inflow (E)/early diastolic tissue Doppler velocity (E') z-score indicated the presence of diastolic dysfunction in both the medical and surgical groups (3.5 ± 4.2, 3.9 ± 2.5 respectively). LV end diastolic pressure (EDP) was correlated with age (r = 0.4, p = 0.05) and LV MVR (r = 0.4, p = 0.05) but not MAVD score (r = −0.1, p = 0.48). On 6-12 month postoperative echocardiograms for surgical patients, aortic valve gradients and aortic regurgitation were significantly improved (aortic valve gradient improved from 65 ± 17 to 28 ± 18mmHg, p = 0.01; aortic regurgitation grade decreased from median of moderate to mild, p < 0.01). LV EDV was normal 6-12 months. LV mass was significantly improved (p < 0.01). Diastolic dysfunction did not change significantly after surgery. The presence of symptoms did not correlate with any measured parameter; however those with symptoms preoperatively had resolution postoperatively.
MAVD is primarily an iatrogenic disease, caused by intervention on diseased aortic valves in neonates and children. Despite significant diastolic dysfunction, systolic function is invariably preserved and symptoms are not correlated with aortic valve function or LV EDP. Current surgical practice preserves LV mechanics and results in short term improvement in valve function and symptoms.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: Aortic Disease
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1246-116
- 2013 American College of Cardiology Foundation