title: Mixed aortic valve disease in the young: initial observations.
abstract: The short-term surgical results for mixed aortic valve disease (MAVD) and the long-term effects on the left ventricle (LV) are unknown. Retrospective review identified patients with at least both moderate aortic stenosis (AS) and aortic regurgitation (AR) before surgical intervention. A one-to-one comparison cohort of patients with MAVD not referred for surgical intervention was identified. The 45 patients in this study underwent surgical management for MAVD. A control group of 45 medically managed patients with MAVD also was identified. Both groups had elevated LV end-diastolic volume (EDV), elevated LV mass, a normal LV mass:volume ratio (MVR), and a normal ejection fraction. Both groups had diastolic dysfunction shown by early diastolic pulsed-Doppler mitral inflow/early diastolic tissue Doppler velocity z-score. The LV end-diastolic pressure (EDP) was correlated with age (R = 0.4; p = 0.03) and LV MVR (R = 0.4; p = 0.03) but not with AS, AR, or the score combining gradient and LV size. As shown by 6- to 12-month postoperative echocardiograms, aortic valve gradients and AR significantly improved (gradient 65 ± 17 to 28 ± 18 mmHg, p = 0.01; median regurgitation grade moderate to mild; p < 0.01), LV EDV normalized, and LV mass significantly improved (p < 0.01). Diastolic dysfunction was unchanged. Symptoms did not correlate with any measured parameter, but the preoperative symptoms resolved. In conclusion, despite diastolic dysfunction, systolic function is invariably preserved, and symptoms are not correlated with aortic valve function or LV EDP. Current surgical practice preserves LV mechanics and results in short-term improvement in valve function and symptoms.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
authors.forename: Allison C
authors.initials: AC
authors.lastname: Hill
authors.forename: David W
authors.initials: DW
authors.lastname: Brown
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.forename: Kimberly
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
authors.forename: James E
authors.initials: JE
authors.lastname: Lock
authors.forename: Rahul H
authors.initials: RH
authors.lastname: Rathod
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D001900:Boston; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000379:methods; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D009929:Organ Size; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume; D063189:Symptom Assessment / Q000379:methods; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology