title: Outcome and growth potential of left heart structures after neonatal intervention for aortic valve stenosis.
abstract: OBJECTIVE
  The purpose of this study was to determine trends of growth of left heart structures after intervention for neonatal aortic valve stenosis.
  
  
  BACKGROUND
  The growth potential of left heart structures in neonatal aortic valve stenosis after relief of obstruction might influence risk for subsequent outcomes.
  
  
  METHODS
  From 1994 to 2004, 53 patients underwent neonatal (< or =30 days old) balloon aortic valve dilation. Factors associated with time-related outcomes (death, reintervention, aortic valve replacement) and longitudinal changes in normalized left heart dimensions were sought.
  
  
  RESULTS
  The median age at intervention was 3.5 days (range 1 to 30 days). During a median follow-up of 3.2 years ranging up to 10.9 years, there were 31 reinterventions on the aortic valve in 21 (40%) patients and 7 deaths (13%). The presence of moderate or severe left ventricular (LV) endocardial fibroelastosis was the only independent predictor for time-related mortality (hazard ratio 22.1; p = 0.004), and a smaller initial aortic valve annulus z-score was a significant independent predictor for aortic valve replacement (hazard ratio 0.63 per 1-U change; p = 0.007). Aortic valve annulus, aortic sinus, and LV dimension z-scores significantly increased over time, whereas mitral valve z-scores remained below normal. The structure's initial z-score and concomitant size of other left heart structures were significant independent factors associated with subsequent z-scores.
  
  
  CONCLUSIONS
  There is potential catch-up growth of the aortic valve and LV over time for neonates after intervention for aortic valve stenosis. However, the continued hypoplasia of the mitral valve warrants further consideration in the long-term management of these patients.
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Ra K
authors.initials: RK
authors.lastname: Han
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Gurofsky
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
authors.forename: Anne I
authors.initials: AI
authors.lastname: Dipchand
authors.forename: William G
authors.initials: WG
authors.lastname: Williams
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Smallhorn
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000792:Angiography; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D002306:Cardiac Volume / Q000502:physiology*; D002404:Catheterization; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008943:Mitral Valve / Q000002:abnormalities / Q000503:physiopathology; D015999:Multivariate Analysis; D012307:Risk Factors; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000628:therapy