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Exercise function of children with congenital aortic stenosis following aortic valvuloplasty during early infancy
Alaina K Kipps1, Doff B McElhinney, Janet Kane
1Department of Cardiology, Children's Hospital, Boston, Mass 02115, USA. akipps@post.harvard.edu
Insights
Most patients treated for neonatal aortic stenosis (AS) with balloon aortic valvuloplasty maintain preserved exercise function. However, a significant subset exhibit reduced peak oxygen consumption (VO2), often due to impaired stroke volume.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Exercise Physiology
Background:
- Balloon aortic valvuloplasty is the standard treatment for neonatal aortic stenosis (AS).
- Potential long-term effects of AS and its treatment on cardiac structure and function can impact exercise capacity.
- Understanding exercise function is crucial for managing patients with a history of neonatal AS.
Purpose of the Study:
- To evaluate the exercise function in patients treated for neonatal AS with balloon aortic valvuloplasty.
- To identify predictors of exercise dysfunction in this patient population.
Main Methods:
- Prospective recruitment of patients over 6 years old with a history of neonatal AS.
- Standardized exercise testing to assess peak oxygen consumption (VO2), O2 pulse, and heart rate.
- Echocardiographic assessment of aortic stenosis gradient and aortic regurgitation.
Main Results:
- Thirty patients (median age 13.1 years) with neonatal AS treated via balloon aortic valvuloplasty were studied.
- Overall peak VO2 was reduced (87% predicted), with severe depression (<70% predicted) in 23% of patients.
- Peak O2 pulse was generally preserved, but 11 patients had O2 pulse <85% predicted; peak heart rate was also reduced overall.
- Age at testing inversely correlated with peak VO2; no other factors were associated with VO2.
Conclusions:
- Exercise function is generally preserved in most individuals treated for neonatal AS in infancy.
- A subset of these patients demonstrate significantly reduced peak VO2, primarily linked to an inability to augment stroke volume.
- Long-term monitoring of exercise capacity is important for patients with a history of neonatal aortic stenosis.
Objectives:
The objectives of this study were to characterize the exercise function of patients treated with balloon aortic valvuloplasty at
Background:
Balloon aortic valvuloplasty is the primary therapy for neonatal aortic stenosis (AS). Residual and/or acquired abnormalities of left heart structure and function may adversely affect exercise capacity. Methods. We prospectively recruited patients >6 years old with a history of neonatal AS to undergo exercise testing.
Results:
We enrolled 30 patients (median age 13.1 years) who underwent balloon aortic valvuloplasty at a median age of 12 days. At time of exercise testing, the median maximum Doppler AS gradient was 34 mm Hg (0-70 mm Hg); 11 patients had moderate or severe aortic regurgitation. All patients were asymptomatic. Overall, peak oxygen consumption (VO(2)) was below normal (87 +/- 18% predicted; P < .001), and was severely depressed (
Conclusion:
Although exercise function is preserved in most patients with a history of AS treated in early infancy, a subset have markedly reduced peak VO(2), usually because of inability to increase stroke volume.
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