title: Aortic Valve Morphology Correlates With Left Ventricular Systolic Function and Outcome in Children With Congenital Aortic Stenosis Prior to Balloon Aortic Valvuloplasty.
abstract: OBJECTIVE
  We sought to determine the relationship between aortic valve morphology and left ventricular (LV) systolic function in children with aortic stenosis (AS) prior to balloon aortic valvuloplasty (BAV).
  
  
  BACKGROUND
  Both aortic valve morphology and LV systolic function have been linked with outcomes in children with congenital AS undergoing BAV. The relationship between aortic valve morphology and LV function is poorly defined despite their importance in regard to outcomes.
  
  
  METHODS
  We performed a retrospective multicenter cohort study of 89 AS patients who underwent BAV between 2007-2013. Pre-BAV echocardiograms were analyzed for: aortic valve opening (AVO); aortic valve type (true bicuspid, functionally bicuspid, or unicuspid); maximal raphe length; aortic valve leaflet symmetry; and valve angle of excursion. The primary endpoint was low function, defined as LV shortening fraction (LVSF) <28%.
  
  
  RESULTS
  Median patient age was 0.17 years (interquartile range [IQR], 0.10-10.74 years) and the median aortic valve mean gradient was 47.00 mm Hg (IQR, 36.75-56.00 mm Hg). Multivariate analysis demonstrated that low AVO (P=.03) was associated with reduced LV function, independent of age or aortic valve gradient (R² = .652). Bicuspid aortic valve (P=.07) was associated with improved LV function compared with functionally unicuspid aortic valve. Low AVO <0.10 was associated with higher adverse outcome.
  
  
  CONCLUSIONS
  LV systolic function is most significantly influenced by degree of valve stenosis. Qualitative aspects such as valve type may also affect LV systolic function. Further study may elucidate whether aortic valve morphology or LV function is the principal predictor of response to BAV and of late outcomes after BAV.
authors: Kevin
authors: K
authors: Gao
authors: Ritu
authors: R
authors: Sachdeva
authors: Bryan H
authors: BH
authors: Goldstein
authors: Sean
authors: S
authors: Lang
authors: Emory University School of Medicine, 1405 Clifton Road, Atlanta, GA 30322 USA. cjpetit@emory.edu.
authors: Christopher J
authors: CJ
authors: Petit
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000000981:diagnostic imaging / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000379:methods* / Q000401:mortality; D000082882:Bicuspid Aortic Valve Disease; D002648:Child; 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; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D015996:Survival Rate; D013599:Systole; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult