Abstract 2212: Outcomes and Growth Potential of Left Heart Structures After Neonatal Intervention in Aortic Valve Stenosis
Background - The growth potential of small left heart structures in neonatal aortic valve stenosis after the relief of obstruction is unclear. We sought to determine longitudinal trends in left heart dimensions, and find factors associated with clinical outcomes and growth of left heart structures in these patients.
Methods and Results - Patient records and echocardiograms of 55 patients who underwent neonatal intervention for aortic valve stenosis at our institution between 1994 and 2004 were reviewed. During a median follow up of 2.9 years (upto 10.9 years), there were 33 reinterventions on the aortic valve in 22 patients (40%) and 8 deaths (15%). Using Cox’s proportionate hazard analysis, the presence of moderate or severe LV endocardial fibroelastosis was the only independent predictor for mortality (P = 0.003), a lower percent change in gradient across the aortic valve with initial intervention was an independent predictor for reintervention (P = 0.007), and a smaller initial aortic valve annulus Z-score was an independent predictor for aortic valve replacement (P = 0.02). Z-scores for aortic valve annulus (P = 0.03) (figure 1⇓) and LV dimension (P = 0.0009) increased to normal over time, whereas mitral valve Z-scores remained below normal. Higher initial and follow-up Z-scores of other left heart structures were independent predictors of growth.
Conclusions -Although neonates with aortic valve stenosis have associated small left heart structures, there is significant catch up growth of the aortic valve and left ventricle over time. However, the continued hypoplasia of the mitral valve warrants further consideration in the longterm management of this patient population.