Does mild valvular aortic stenosis progress during childhood?
OBJECTIVE
An increased gradient in congenital valvular aortic stenosis (AS) during follow up remains the subject of controversy, and may determine a need for treatment in pediatric patients. It is hypothesized that a valvular gradient < 40 mmHg indicates a stable tendency at follow up for congenital valvular AS.


METHODS
Twenty-five cases with valvular AS, isolated but not treated, were followed for eight years (range: 0.14-18.8 years). Clinical and complementary tests (electrocardiography, X-radiography) were undertaken. The gradient anatomy and function were measured using M-mode, two-dimensional, and Doppler echocardiography.


RESULTS
No significant changes were noted in symptoms or at physical examination. Signs of cardiac enlargement were decreased (p < 0.001), and the functional status and gradient remained stable during the follow up period (mean difference 2.38 mmHg; p = 0.74). The relationship between gradient and age showed a slowly increasing trend (r = 0.20).


CONCLUSIONS
The trend in gradient confirmed the stable nature of mild AS. Patients in whom gradients were < 40 mmHg at the time of diagnosis remained stable and required no treatment. Subsequent follow up control and clinical management of these patients may be performed at intervals of two years, or more.
Pediatric Cardiology, University Hospital, Facultad de Medicina, Valladolid, Spain. ardura@ped.uva.es
Julio
J
Ardura
Carmen
C
Gonzalez
Jesus
J
Andres
D000293:Adolescent; D000367:Age Factors; D001022:Aortic Valve Insufficiency / Q000151:congenital / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left