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Outcome and growth potential of left heart structures after neonatal intervention for aortic valve stenosis

Ra K Han1, Rebecca C Gurofsky, Kyong-Jin Lee

  • 1Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.

Journal of the American College of Cardiology
|December 25, 2007
PubMed

Insights

Neonatal aortic valve stenosis intervention allows aortic valve and left ventricle catch-up growth. However, persistent mitral valve hypoplasia requires ongoing management consideration.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Echocardiography

Background:

  • Neonatal aortic valve stenosis (AVS) poses risks due to impaired left heart development.
  • Understanding growth potential post-intervention is crucial for long-term outcomes.

Purpose of the Study:

  • To assess longitudinal growth trends of left heart structures after neonatal AVS intervention.
  • To identify factors influencing growth and subsequent clinical outcomes.

Main Methods:

  • Retrospective analysis of 53 neonates (<30 days) undergoing balloon aortic valve dilation (1994-2004).
  • Evaluation of time-related outcomes (mortality, reintervention, replacement) and normalized left heart dimensions.
  • Statistical analysis to determine predictors of outcomes and growth patterns.

Main Results:

  • Significant catch-up growth observed in aortic valve annulus, aortic sinus, and left ventricular (LV) dimensions post-intervention.
  • Moderate/severe LV endocardial fibroelastosis independently predicted mortality (HR 22.1).
  • Smaller initial aortic valve annulus z-score predicted aortic valve replacement (HR 0.63). Mitral valve z-scores remained subnormal.

Conclusions:

  • Neonates with AVS show potential for catch-up growth in aortic valve and LV dimensions after intervention.
  • Persistent mitral valve hypoplasia is a key concern for long-term management strategies.
  • Early intervention and monitoring of cardiac structures are vital for improving patient outcomes.
Abstract

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