title: The Impact of Aortic Valve Replacement on Left Ventricular Remodeling in Children.
abstract: There are scant data in pediatrics on the optimal timing for aortic valve repair (AVR). This study assesses the midterm response to AVR and possible predictors of poor outcome. From 2001 to 2006, 41 patients had greater than 3-month follow-up after AVR for aortic insufficiency, aortic stenosis, or both. Pre-, peri-, and post-operative data were collected, including demographics and clinical symptoms. Two reviewers measured echocardiographic parameters from the pre-operative and latest follow-up echocardiograms. Ventricular dimensions were indexed to body surface area (z-score). Median age at AVR was 13 years with 83 % having a Ross operation. The average left ventricular end-diastolic dimension pre-op, z-score of +1.3, significantly decreased at last follow-up to a mean z-score of -0.1 (p < 0.001). Similarly the indexed LV mass decreased from +3.9 to +0.5 (p < 0.001). There was no significant correlation between the presence of pre-op symptoms and the presence of post-op LV dilatation, hypertrophy, or dysfunction. In the subset of patients (7/41) with persistent LV dysfunction at last follow-up, there was a significant correlation with pre-op LV dilatation as assessed by both LVEDD (p = 0.02) and LVESD (p = 0.05). Children demonstrate significant reverse remodeling after AVR. Pre-op LV dilatation may predict patients with persistent LV dysfunction post-AVR. Symptoms are less useful in children, suggesting the need for more objective data for functional assessment.
authors.affiliation: Division of Pediatric Cardiology, Medical College of Wisconsin, MS-713, 9000 W. Wisconsin Ave., Milwaukee, WI, 53226, USA. asingh@chw.org.
authors.forename: Anoop K
authors.initials: AK
authors.lastname: Singh
authors.affiliation: Brenner Children's Hospital, Wake Forest University, Winston Salem, NC, 27157, USA.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Ungerleider
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, G-0039, Seattle, WA, 98105, USA.
authors.forename: Yuk M
authors.initials: YM
authors.lastname: Law
mesh_terms: D000293:Adolescent; D001021:Aortic Valve; D001024:Aortic Valve Stenosis; D002648:Child; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Aortic insufficiency; Aortic stenosis; Aortic valve replacement; Pediatrics; Ventricular remodeling