Left Heart Growth, Function, and Reintervention After Balloon Aortic Valvuloplasty for Neonatal Aortic Stenosis

McElhinney, Doff B.; Lock, James E.; Keane, John F.; Moran, Adrian M.; Colan, Steven D.

doi:10.1161/01.cir.0000153809.88286.2e

Cited by 189 publications

(152 citation statements)

References 22 publications

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“…In our patients, the size of the aortic annulus normalized, and LV dimensions significantly improved in up to 85% of the cases. Similar findings are reported in the literature for patients with critical aortic stenosis after neonatal balloon valvuloplasty of the AO [12] and for patients with LHL after coarctation repair, relief of potential LVOT obstruction, or both [1,20].…”

Section: Discussionsupporting

confidence: 88%

Outcome of Biventricular Repair in Infants With Multiple Left Heart Obstructive Lesions

et al. 2011

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The decision to perform biventricular repair for infants with multiple obstructive or hypoplastic left heart lesions (LHL) and borderline left ventricle (LV) may be controversial. This study sought to assess the mortality and morbidity of patients with LHL after biventricular repair and to determine the growth of the left-sided cardiac structures. Retrospective analysis of 39 consecutive infants with LHL who underwent biventricular repair was performed. The median age at surgery was 7 days (range 1-225 days), and the median follow-up period was 34 months (range 1-177 months). Between diagnosis and the end of the follow-up period, the size of the aortic annulus (z-score -4.1 ± 2.8 vs. -0.1 ± 2.7) and the LV (LV end-diastolic diameter z-score -1.7 ± 2.8 vs. 0.21 ± 1.7) normalized. During the follow-up period, 23 patients required 39 reinterventions (62%) consisting of redo surgery for 21 patients (57%) and catheter-guided reinterventions for 8 patients (22%). At the end of the follow-up period, 25 of 34 patients were doing subjectively well; 10 children (29%) received cardiac medication; 12 (35%) presented with failure to thrive (weight ≤ P3) and 5 (15%) with pulmonary hypertension. The overall mortality rate was 13%. Biventricular repair for patients with multiple LHL results in sufficient growth of the left-sided cardiac structures. Nevertheless, residual or newly developing obstructive lesions and pulmonary hypertension are frequent, causing significant morbidity that requires reintervention.

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Section: Discussionsupporting

confidence: 88%

Outcome of Biventricular Repair in Infants With Multiple Left Heart Obstructive Lesions

et al. 2011

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“…After successful aortic balloon valvotomy in newborns, the LV remodels and grows toward normal values by 1 year of life. 453 Outcome for infants born with critical aortic valve stenosis has improved steadily, and 5-year survival rates are between 77% and 85% at 5 years. 454,455 The risk of sudden death in children after balloon aortic valvuloplasty is highest in infants with elevated PAP beyond 1 month of age.…”

Section: Aortic Stenosismentioning

confidence: 99%

“…454,455 The risk of sudden death in children after balloon aortic valvuloplasty is highest in infants with elevated PAP beyond 1 month of age. 453 PH can persist throughout childhood in some patients 4 to 12 years after treatment of congenital aortic valve stenosis in infancy. LV diastolic dysfunction contributes significantly to PH in these children.…”

Section: Aortic Stenosismentioning

confidence: 99%

Pediatric Pulmonary Hypertension

Abman¹,

Hansmann²,

Archer³

et al. 2015

Circulation

916

405

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Abstract-Pulmonary hypertension is associated with diverse cardiac, pulmonary, and systemic diseases in neonates, infants, and older children and contributes to significant morbidity and mortality. However, current approaches to caring for pediatric patients with pulmonary hypertension have been limited by the lack of consensus guidelines from experts in the field. In a joint effort from the American Heart Association and American Thoracic Society, a panel of experienced clinicians and clinician-scientists was assembled to review the current literature and to make recommendations on the diagnosis, evaluation, and treatment of pediatric pulmonary hypertension. This publication presents the results of extensive literature reviews, discussions, and formal scoring of recommendations for the care of children with pulmonary hypertension. Key Words: AHA Scientific Statements ◼ bronchopulmonary dysplasia ◼ congenital diaphragmatic hernia ◼ congenital heart disease ◼ genetics ◼ persistent pulmonary hypertension of the newborn ◼ sickle cell disease © 2015 by the American Heart Association, Inc., and the American Thoracic Society.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000329 †Deceased. The American Heart Association and the American Thoracic Society make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on May 12, 2015, the American Heart Association Executive Committee on July 22, 2015, and the American Thoracic Society on July 24, 2015.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIR.0000000000000329/-/DC1. The American Heart Association requests that this document be cited as follows: Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thébaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL; on behalf of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Surgery and Anesthesia, and the American Thoracic Society. Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society. Circulation. 2015;132:2037-2099 Copies: This document is available on the World Wide Web site of the American Heart Associat...

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“…The causes of death were multifactorial: In four cases, death was considered secondary to BAV complications, and in eight cases (8/11-72 %), patients were finally diagnosed with a ''borderline LV'' with abnormal left heart structures or non-compliant LV, clearly associated with an increased risk of poor results and death [14]. When neonates are diagnosed with a ''borderline LV,'' predicting which is suitable for biventricular repair remains a substantial challenge [2,5,11] and the presence of endocardial fibroelastosis with LV diastolic dysfunction appears to be a more significant risk factor than LV volume or dimensions [14]. LV systolic dysfunction preceding BAV also tended to be associated with poor survival.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

et al. 2015

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In the presence of new surgical techniques, the treatment of congenital valvular aortic stenosis is under debate. We reviewed the results and late outcomes of all 93 patients aged 1 day to 18 years, treated with balloon valvuloplasty (BAV) as first-line therapy for congenital aortic valve stenosis in our center from January 1991 to May 2012. Mean age at procedure time was 2.4 years; 37 patients underwent BAV at age ≤30 days (neonates), 29 patients at age ≥1 month and <1 year (infants), and 27 patients were older than 1 year (children). The invasive BAV peak-to-peak aortic valve gradient (mean 59 ± 22 mmHg) was immediately reduced (mean 24 ± 12 mmHg). The observed diminution of gradient was similar for each age group. Four patients had significant post-BAV AI. Mean follow-up after BAV was 11.4 ± 7 years. The last echo peak aortic gradient was 37 ± 18 mmHg and mean gradient was 23 ± 10 mmHg, and two patients had significant AI. Actuarial survival for the whole cohort was 88.2 and 72.9 % for the neonates. All infants, except one, and all children survived. Sixty-six percent of patients were free from surgery, and 58 % were free from any reintervention, with no difference according to age. Freedom from surgery after BAV at 5, 10, and 20 years, respectively, was 82, 72, and 66 %. Our study confirms that BAV as primary treatment for congenital AS is an efficient and low-risk procedure in infants and children. In neonates, the prognosis is more severe and clearly related to "borderline LV."

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Left Heart Growth, Function, and Reintervention After Balloon Aortic Valvuloplasty for Neonatal Aortic Stenosis

Cited by 189 publications

References 22 publications

Outcome of Biventricular Repair in Infants With Multiple Left Heart Obstructive Lesions

Outcome of Biventricular Repair in Infants With Multiple Left Heart Obstructive Lesions

Pediatric Pulmonary Hypertension

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

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