Abstract 15680: Predictors of Left Ventricular Remodeling and Function After Aortic Valve Replacement in Pediatric Patients With Isolated Aortic Regurgitation
Purpose: There is controversy regarding the appropriate timing of surgery in asymptomatic or minimally symptomatic patients with isolated aortic regurgitation. In the pediatric age group, there are limited studies in this regard and most of them are on combined aortic valve stenosis and regurgitation.
Methods: All patients with biventricular physiology and morphologic left ventricle (LV) who underwent aortic valve surgery for aortic regurgitation from January 1988 to July 2010 were included in the study. Demographic, clinical and echocardiographic data were collected at pre-surgical visit, early post -operative, one year and most recent follow up.
Results: Among 53 patients (37 males, 16 females), 18 had LV end diastolic diameter (LVEDD) z-score > 4SD (group I) and 35 had LVEDD < 4SD (group II). 39 had long term follow up. Mean age at surgery was 11.9 ± 5.9 yrs; mean follow up was 6.9 ± 5.6 yrs. LVEDD and LVESD were significantly lower in group II compared to group I at early and one year follow up. Pre-operative LVEDD >4 SD significantly predicted persistent LV dilation (>2 SD) at 1 yr (p<0.05). Pre-operative decreased LV function (fractional shortening <28%) was the only significant predictor of persistent LV dysfunction at most recent follow up and requirement for repeat interventions (p<0.01).
Conclusion: In children with aortic regurgitation, preoperative LV dysfunction and extreme LV dilation (> 4SD) are significant predictors of incomplete LV remodeling or persistent LV dysfunction.
- © 2011 by American Heart Association, Inc.