title: Left ventricular remodeling and improvement in diastolic function after balloon aortic valvuloplasty for congenital aortic stenosis.
abstract: BACKGROUND
  In congenital aortic stenosis, chronic pressure load has detrimental effects on left ventricular (LV) systolic and diastolic function. Reduction in LV pressure load with balloon aortic valvuloplasty (BAVP) may improve diastolic function.
  
  
  RESULTS
  Echocardiographic and catheterization data for 25 consecutive patients undergoing BAVP for congenital aortic stenosis were retrospectively analyzed. Median age at BAVP was 11.5 years (3.2-40.1). LV end-diastolic pressure was elevated (≥15 mm Hg) in 72% of patients, with a median of 17 mm Hg (range, 9-24). With BAVP, median aortic stenosis gradient was reduced from 63 mm Hg (range, 44-105) to 30 mm Hg (range, 10-43). Aortic regurgitation increased from trivial (none to mild) to mild (trivial to moderate). Pre-BAVP early diastolic mitral inflow velocity/tissue Doppler early diastolic velocity (E/E´) correlated with LV end-diastolic pressure (r=0.52, P=0.007). On follow-up echocardiography (median, 11 months after BAVP), aortic stenosis gradient was lower (P<0.001) and degree of AR was higher (P=0.01) compared with pre-BAVP echocardiograms. LV end-diastolic volume z-score increased (P=0.02), LV mass was unchanged, and LV mass:volume decreased (P=0.002). Mitral annular and septal E´ (P<0.001) were higher and E/E´ was lower after dilation (10.8 versus 14.2, P<0.001). Lower pre-BAVP E/E´ and lower pre-BAVP LV mass z-score were associated with lower post-BAVP E/E.
  
  
  CONCLUSIONS
  After BAVP, LV remodeling characterized by an increase in EDV and decrease in LV mass:volume occurs and echocardiographic measures of diastolic function and LV end-diastolic pressure improve in most patients. Risk factors for persistent diastolic dysfunction include higher pre-BAVP LV mass z-score and worse pre-BAVP diastolic function.
authors: Department of Cardiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA. Kevin.Friedman@cardio.chboston.org
authors: Kevin G
authors: KG
authors: Friedman
authors: Doff B
authors: DB
authors: McElhinney
authors: Steven D
authors: SD
authors: Colan
authors: Diego
authors: D
authors: Porras
authors: Andrew J
authors: AJ
authors: Powell
authors: James E
authors: JE
authors: Lock
authors: David W
authors: DW
authors: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology*; D055815:Young Adult