title: Aortic valve morphology is associated with outcomes following balloon valvuloplasty for congenital aortic stenosis.
abstract: OBJECTIVE
  Evaluate the incidence of various morphologic types of congenital AS, and the association between valve morphology and long-term outcomes, including repeat BAV, AVR, and death/transplant.
  
  
  BACKGROUND
  Reports on long-term outcomes have low agreement on the influence of morphologic type.
  
  
  METHODS
  We queried our institutional database and hospital billing records to identify all patients who underwent balloon aortic valvuloplasty (BAV) from 1992 through 2009. We excluded cases where morphology was not clear based on the description in the pre-BAV echocardiogram report and patients who underwent single ventricle palliation. The primary outcome of the study was the occurrence of any of the following events: repeat valvuloplasty, AVR, heart transplant, or death.
  
  
  RESULTS
  There were 147 patients in our study cohort. The most common morphology was functionally bicuspid (n = 92, 63%), followed by functionally unicuspid (n = 20, 14%), dysplastic (n = 16, 11%), true bicuspid (n = 13, 9%), and true unicuspid (n = 6, 4%). The primary endpoint was less likely to occur in patients with functionally bicuspid valves (P < 0.01) and patients with true bicuspid valves (P = 0.03), whereas it was more likely to occur in patients with functionally unicuspid valves (P = 0.02) and patients with true unicuspid valves (P = 0.05). Multivariate Cox regression analysis demonstrated that valve type other than functionally bicuspid was associated with diminished freedom from repeat intervention, death or transplant (HR 3.3, CI 1.2 - 8.6, P = 0.02).
  
  
  CONCLUSIONS
  In our cohort, patients with functionally bicuspid aortic valves, the most common type, had improved outcomes as compared with all other morphologic types.
authors.affiliation: Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA. samaskat@texaschildrenshospital.org
authors.forename: Shiraz A
authors.initials: SA
authors.lastname: Maskatia
authors.forename: Henri
authors.initials: H
authors.lastname: Justino
authors.forename: Frank F
authors.initials: FF
authors.lastname: Ing
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Crystal
authors.forename: Raphael J
authors.initials: RJ
authors.lastname: Mattamal
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
mesh_terms: D000367:Age Factors; D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000379:methods*; D000082882:Bicuspid Aortic Valve Disease; D002675:Child, Preschool; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome