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The Impact of Aortic Valve Replacement on Left Ventricular Remodeling in Children

Anoop K Singh1, Ross M Ungerleider2, Yuk M Law3

  • 1Division of Pediatric Cardiology, Medical College of Wisconsin, MS-713, 9000 W. Wisconsin Ave., Milwaukee, WI, 53226, USA. asingh@chw.org.

Pediatric Cardiology
|May 22, 2016
PubMed

Insights

Pediatric aortic valve repair (AVR) leads to significant reverse remodeling, improving ventricular size and mass. Pre-operative left ventricular dilatation may predict persistent dysfunction, highlighting the need for objective assessments in children.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Limited data exist on optimal timing for pediatric aortic valve repair (AVR).
  • Assessing midterm outcomes and predictors of poor results after AVR in children is crucial.

Purpose of the Study:

  • To evaluate the midterm response to aortic valve repair (AVR) in pediatric patients.
  • To identify predictors of poor outcomes following AVR in children.

Main Methods:

  • Retrospective analysis of 41 pediatric patients undergoing AVR between 2001 and 2006 with >3 months follow-up.
  • Collection of pre-, peri-, and post-operative data, including demographics and symptoms.
  • Echocardiographic parameters (ventricular dimensions, mass) were measured and indexed to body surface area (z-score) pre-operatively and at follow-up.

Main Results:

  • Significant reduction in indexed left ventricular end-diastolic dimension (z-score +1.3 to -0.1, p<0.001) and indexed left ventricular mass (z-score +3.9 to +0.5, p<0.001) post-AVR.
  • No significant correlation found between pre-operative symptoms and post-operative left ventricular (LV) dilatation, hypertrophy, or dysfunction.
  • Pre-operative LV dilatation (LVEDD, LVESD) correlated with persistent LV dysfunction at follow-up in a subset of patients (7/41).

Conclusions:

  • Pediatric patients show significant reverse remodeling after aortic valve repair (AVR).
  • Pre-operative left ventricular dilatation is a potential predictor of persistent LV dysfunction post-AVR.
  • Clinical symptoms are less reliable indicators in children; objective functional assessments are needed.

Keywords:
Aortic insufficiencyAortic stenosisAortic valve replacementPediatricsVentricular remodeling

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