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Variation in management of paediatric isolated bicuspid aortic valve: current practice survey
Jesse M Boyett Anderson1, John S Hokanson2
1Department of Pediatrics, University of Wisconsin, Madison, WI, USA.
Insights
Current pediatric bicuspid aortic valve (BAV) care varies from new guidelines. This study compares current follow-up, treatment, and intervention strategies with recent appropriate use criteria to improve care for children with BAV.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Congenital Heart Disease
Background:
- Follow-up for valvular lesions in children, including isolated bicuspid aortic valve (BAV), lacked standardization before new imaging guidelines.
- Current practices for BAV management in children up to 18 years old were assessed.
Purpose of the Study:
- To describe current follow-up, treatment, and intervention strategies for isolated BAV in children.
- To compare these strategies with newly released appropriate use criteria.
Main Methods:
- An online survey was distributed to members of the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and PediHeartNet.
- 106 responses with interpretable data were analyzed.
Main Results:
- Follow-up intervals for asymptomatic BAV patients without stenosis, regurgitation, or dilation increased with age.
- Most respondents medically treated aortic regurgitation or dilation.
- Intervention was generally recommended for severe stenosis or regurgitation, but not routinely for severe dilation in young children.
Conclusions:
- Current management strategies for pediatric isolated BAV differ from appropriate use criteria.
- Discrepancies highlight the need for clearer guidelines and wider adoption of established criteria.
Background:
Prior to the recent release of appropriate use criteria for imaging valvulopathies in children, follow-up of valvular lesions, including isolated bicuspid aortic valve, was not standardised. We describe current follow up, treatment, and intervention strategies for isolated bicuspid aortic valve with varying degrees of stenosis, regurgitation, and dilation in children up to 18 years old and compare them with newly released appropriate use criteria.
Methods:
Online survey was sent to members of the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and PediHeartNet.
Results:
Totally, 106 responses with interpretable data were received. For asymptomatic patients with isolated BAV without stenosis, regurgitation, or dilation follow-up-intervals increased from 7+/-4 months in the newborn period to 28 +/- 14 months at 18 years of age. Respondents recommended more frequent follow-up for younger patients and those with greater disease severity. More than 80% of respondents treat aortic regurgitation or aortic dilation in the setting of bicuspid aortic valve medically. In general, intervention was recommended once stenosis or regurgitation became severe (stenosis of >4 m/s; regurgitation with LV Z score 4) regardless of age, but was not routinely recommended for younger children (newborn - age 6 years) with severe dilation. Exercise was restricted at 38+/-11 mmHg echocardiographic mean gradient.
Conclusions:
Current follow-up, treatment, and intervention strategies for isolated bicuspid aortic valve deviate from appropriate use criteria. Differences between the two highlight the need to better delineate the disease course, clarify recommendations for care, and encourage wider adoption of guidelines.
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