title: Diminished left ventricular function is associated with poor mid-term outcomes in neonates after balloon aortic valvuloplasty.
abstract: OBJECTIVE
  We studied outcomes of neonatal aortic valvuloplasty to determine the risk factors for poor outcomes.
  
  
  BACKGROUND
  Balloon aortic valvuloplasty (BAV) is the primary therapy for neonates with severe aortic stenosis (AS). Limited data are available on the mid-term and long-term outcomes in this population, and reported risk factors for poor outcomes vary among studies.
  
  
  METHODS
  We reviewed all cases of BAV in neonates in our institution between 1998 and 2009. We reviewed patient characteristics, preintervention echocardiographic, and procedural details. We tracked repeat BAV, aortic valve replacement (AVR), and death/transplant. Kaplan-Meier and Cox regression analyses were performed. Changes in dimensions of left heart structures post-BAV were also studied.
  
  
  RESULTS
  Forty-eight neonates were included-of these, 30 (62%) had critical AS. There was one procedural death. The remaining 47 neonates were followed for 4.8 ± 4.4 years. Repeat BAV was performed in 19 (40%) neonates; AVR was performed in 9 (19%), and death/transplant occurred in 4 (8%) neonates. Multivariate analysis revealed that lower LV shortening fraction pre-BAV, higher pre-BAV and final valve gradient, and need for inotropes were associated with poor long-term outcomes. LV diastolic and systolic dimensions normalized over time, and left heart structures improved in size early and late after BAV.
  
  
  CONCLUSIONS
  Neonatal BAV is associated with low mortality. Lower LV shortening fraction pre-BAV is associated with risk of future interventions, while repeat valvuloplasty is safe and effective for recurrent AS. There is significant improvement in dimensions of the LV and aortic valve annulus following BAV.
authors.affiliation: Lillie-Frank Abercrombie Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA. petit@bcm.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
authors.forename: Frank F
authors.initials: FF
authors.lastname: Ing
authors.forename: Raphael
authors.initials: R
authors.lastname: Mattamal
authors.forename: Ricardo H
authors.initials: RH
authors.lastname: Pignatelli
authors.forename: Charles E
authors.initials: CE
authors.lastname: Mullins
authors.forename: Henri
authors.initials: H
authors.lastname: Justino
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left