Growth of left ventricular outflow tract and predictors of future re-intervention after repair for ventricular septal defect and aortic arch obstruction

Jijeh, Abdulraouf; Ismail, Muna; Alhabshan, Fahad

doi:10.1017/s104795111700018x

Cited by 6 publications

(3 citation statements)

References 20 publications

(30 reference statements)

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“…In both groups (bicuspid/tricuspid aortic valve) the aortic valve diameter became significantly larger at the 1-year follow-up, approximating the normal value. Significant LVOT growth after repair of aortic obstruction with VSD in 89 patients was observed also by Jijeh et al [18]. The recent study of Plymale et al found normalization of the aortic valve z-score at follow-up, but residual aortic arch obstruction persisted in one-third of subjects [19].…”

Section: Discussionmentioning

confidence: 58%

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Predictors of Left Ventricular Outflow Tract Obstruction After Conventional Repair for Patients with Interrupted Aortic Arch or Coarctation of the Aorta, Combined with Ventricular Septal Defect: A Single-Center Experience

et al. 2021

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Left ventricular outflow tract obstruction (LVOTO) affects survival and reoperation rates after surgical treatment of patients with interruption of the aortic arch (IAA) or coarctation of the aorta (CoA) with ventricular septal defect (VSD). The aim of the study was to determine predictors of LVOTO and to evaluate the relationship between aortic valve (AoV) morphology and the re-intervention rate. Retrospective review of patients, who underwent a conventional repair for IAA/CoA with VSD at a tertiary referral center between 1996 and 2017. The preoperative demographic data as well as pre- and post-operative echocardiographic parameters and re-interventions were reviewed. In the median follow-up of 8.3 years (range of 6.15–10.27) 5 patients (11.9%) from a total of 47 patients included in the study presented with a significant LVOTO. Four of them required reoperation after median period of 2.3 years (range of 0.3–7.9) after the initial surgery. Multivariable logistic regression identified AoV z-score (OR 0.44, p = 0.017) as predictor of LVOTO. The mean AoV z-score before the primary repair was significantly smaller in those with LVOTO as compared to those with unobstructed flow from the LV (− 3.58 ± 1.96 vs. − 1.44 ± 1.55; p = 0.0016). At 1-year follow-up, both groups showed an increase in the AoV z-score (p = 0.98). The re-intervention rate after primary repair (both surgical procedures and percutaneous interventions), either for LVOTO or reCoA, was higher in patients with AoV z-score ≤ − 3 (p = 0.007 vs. p = 0.46) and those, whose aortic annulus was less or equal than patient’s weight (kg) + 1.5 mm as compared to those with larger aortic annulus (p = 0.03 vs. p = 0.16). In patients after surgical treatment of IAA/CoA with VSD, the AoV z-score at diagnosis is a significant risk factor for reoperation for LVOTO. With age, AoV growth and z-score improvement is expected. Small AoV at diagnosis is correlated with increased rate of re-intervention for LVOTO and reCoA.

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Section: Discussionmentioning

confidence: 58%

“…Recently, Jijeh et al analyzed the growth and predictors of future obstruction of the LVOT after repair for VSD and aortic obstruction [18]. They reported that small aortic valve and LVOT at diagnosis are not risk factors to predict the need for surgical re-intervention for LVOTO in future.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Left Ventricular Outflow Tract Obstruction After Conventional Repair for Patients with Interrupted Aortic Arch or Coarctation of the Aorta, Combined with Ventricular Septal Defect: A Single-Center Experience

et al. 2021

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“…LVOTO occurs in 20–40% of cases following IAA repair, almost always necessitates reintervention, and is associated with increased mortality [ 2 ]. Left Ventricular Outflow Tract (LVOT) formation and size are theorized to be flow-mediated [ 3 ], with previous studies alluding to the associations between aortic valve area [ 4 , 5 ], aortic root diameter [ 6 , 7 ], hypoplastic left heart syndrome [ 8 ] or acquired cardiac conditions [ 9 , 10 ] on LVOT diameter. As such, IAA morphology may also cause abnormal or reduced flow resulting in LVOT hypoplasia.…”

Section: Introductionmentioning

confidence: 99%

Association of left ventricular outflow tract size with arch morphology in interrupted aortic arch

Elbatarny,

Lee,

Howell

et al. 2024

European Journal of Cardio-Thoracic Surgery

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Objectives Left ventricular outflow tract obstruction (LVOTO) is a major cause of morbidity and mortality in infants with interrupted aortic arch (IAA). LVOT development may be flow-mediated, thus IAA morphology may influence LVOT diameter and subsequent reintervention. We investigated the association of IAA morphology (type and presence of aortic arch aberrancy) with LVOT diameter and reintervention. Methods All surgical patients with IAA (2001-2022) were reviewed at a single institution. We compared IAA-A versus IAA-B; IAA with aortic arch aberrancy (AAb) versus none; IAA-B with aberrant subclavian artery (AAbS) versus Others. Primary outcomes included LVOT diameter (mm), LVOTO at discharge (≥50mmHg), and LVOT reintervention. Results Seventy-seven infants (mean age 10±19 days) were followed for 7.6 (5.5-9.7) years. Perioperative mortality was 3.9% (3/77) and long-term mortality was 5.2% (4/77). Out of 51 IAA-B (66%) and 22 IAA-A (31%) patients, 30% (n = 22) had AAb. Smaller LVOT diameter was associated with IAA-B [IAA-A: 5.40 (4.68-5.80), IAA-B: 4.60 (3.92-5.50), p = 0.007], AAb [AAb: 4.00 (3.70-5.04) vs None: 5.15 (4.30-5.68) p = 0.006], and combined IAA-B+AAbS [IAA-B+AAbS: 4.00 (3.70-5.02) vs Other: 5.00 (4.30-5.68), p = 0.002]. The likelihood of LVOTO was higher among AAb (N = 6 (25%) vs N = 1 (2%), p = 0.004) and IAA-B+AAbS (N = 1 (2%) vs N = 6 (30%), p = 0.002). Time-to-event analysis showed a signal towards increased LVOT reintervention in IAA-B+AAbS (p = 0.11). Conclusion IAA-B and AAb are associated with small LVOT diameter and early LVOTO, especially in combination. This may reflect lower flow in the proximal arch during development. Most reinterventions occur in IAA-B+AAbS, hence these patients should be carefully considered for LVOT intervention at the time of initial repair.

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Clinical Outcomes and Echocardiographic Predictors of Reintervention After Interrupted Aortic Arch Repair

McMullen,

Harrington,

Blitzer

et al. 2024

Pediatr Cardiol

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Growth of left ventricular outflow tract and predictors of future re-intervention after repair for ventricular septal defect and aortic arch obstruction

Cited by 6 publications

References 20 publications

Predictors of Left Ventricular Outflow Tract Obstruction After Conventional Repair for Patients with Interrupted Aortic Arch or Coarctation of the Aorta, Combined with Ventricular Septal Defect: A Single-Center Experience

Predictors of Left Ventricular Outflow Tract Obstruction After Conventional Repair for Patients with Interrupted Aortic Arch or Coarctation of the Aorta, Combined with Ventricular Septal Defect: A Single-Center Experience

Association of left ventricular outflow tract size with arch morphology in interrupted aortic arch

Clinical Outcomes and Echocardiographic Predictors of Reintervention After Interrupted Aortic Arch Repair

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