title: Predictors of left ventricular remodeling after aortic valve replacement in pediatric patients with isolated aortic regurgitation.
abstract: OBJECTIVE
  To identify the risk factors that could predict postoperative outcome after aortic valve replacement in pediatric patients with isolated aortic regurgitation (AR).
  
  
  BACKGROUND
  There is controversy regarding the appropriate timing of surgery in asymptomatic or minimally symptomatic patients with isolated AR. In the pediatric age group, there are limited studies in this regard and most of them are on combined aortic valve stenosis and regurgitation.
  
  
  METHODS
  All patients with biventricular physiology and morphologic left ventricle (LV) who underwent aortic valve surgery for AR from January 1988 to July 2010 were included in the study. Demographic, clinical, and echocardiographic data were collected at presurgical visit, early postoperative, 1 year, and most recent follow-up.
  
  
  RESULTS
  Among 53 patients (36 males), 18 had LV end-diastolic diameter (LVEDD) z-score >4 standard deviation (SD) (group I) and 35 had LVEDD <4 SD (group II). Forty-one had long-term follow-up. Mean age at surgery was 11.6 ± 5.9 years; mean follow-up was 6.9 ± 5.6 years. Preoperative LVEDD >4 SD predicted persistent LV dilation (>2 SD) at early post-op (P < .05) and 1 year follow-up (P = .09). Preoperative decreased LV function (fractional shortening <28%) was the only significant predictor of persistent LV dysfunction at most recent follow-up and requirement for repeat interventions (P < .01). Most have reduction of LV dimensions in the immediate postoperative period to normal limits.
  
  
  CONCLUSIONS
  In children with AR, preoperative LV dysfunction and extreme LV dilation (>4 SD) are significant predictors of incomplete LV remodeling or persistent LV dysfunction.
authors.affiliation: Section of Pediatric Cardiology and Cardiovascular Surgery, Carmen and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Mich, USA. drbuddhe@gmail.com
authors.forename: Sujatha
authors.initials: S
authors.lastname: Buddhe
authors.forename: Wei
authors.initials: W
authors.lastname: Du
authors.forename: Henry L
authors.initials: HL
authors.lastname: Walters
authors.forename: Ralph
authors.initials: R
authors.lastname: Delius
authors.forename: Michael D
authors.initials: MD
authors.lastname: Pettersen
mesh_terms: D000293:Adolescent; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling