Annals of Thoracic Surgery

Publication date: 2008-01
Volume: 85 Pages: 604 - 610
ISSN: 0003-4975, 1552-6259 PMID: 18222274
DOI: 10.1016/j.athoracsur.2007.10.035
Publisher: Elsevier Science

Author:

Arnold, R
Ley-Zaporozhan, J ; Ley, S ; Loukanov, T ; Sebening, C ; Kleber, JB ; Goebel, B ; Hagl, S ; Karck, M ; Gorenflo, Matthias

Keywords:

Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Respiratory System, Surgery, Cardiovascular System & Cardiology, ROSS OPERATION, VENTRICULAR DIMENSIONS, REGURGITATION, MASS, ECHOCARDIOGRAPHY, QUANTIFICATION, EXPERIENCE, INFANTS, DISEASE, STRAIN, Adolescent, Adult, Aortic Valve Insufficiency, Bioprosthesis, Cardiac Catheterization, Cardiopulmonary Bypass, Child, Cohort Studies, Echocardiography, Doppler, Follow-Up Studies, Heart Valve Prosthesis Implantation, Humans, Linear Models, Magnetic Resonance Imaging, Probability, Retrospective Studies, Risk Assessment, Severity of Illness Index, Treatment Outcome, 1103 Clinical Sciences, 1102 Cardiorespiratory Medicine and Haematology

Abstract:

BACKGROUND: We asked whether aortic valve replacement using a mechanical prosthesis would allow normalization of left ventricular function and structure in children and young adults. METHODS: We performed a clinical follow-up examination in 30 patients with aortic valve replacement at 25 years of age or younger, including conventional and tissue Doppler echocardiography and magnetic resonance imaging. RESULTS: Aortic valve replacement was performed at the median age of 14.3 years (range, 7.6 to 24.3 years) using a mechanical prosthesis (St. Jude Medical; median diameter, 23 mm; range, 17 to 27 mm). Indications were severe aortic stenosis in 6 of 30 patients, aortic regurgitation in 20 of 30 patients, or a combination of aortic stenosis and regurgitation (4 of 30 patients). Aortic valve replacement was a reoperation in 12 of 30 patients who primarily underwent aortic valvotomy at a median of 7.1 years (range, 1.0 to 11.3 years). In-hospital mortality was 0%. Follow-up was a median of 6 years (range, 1.2 to 14.5 years). Twenty-nine of 30 patients were in New York Heart Association functional class I without thromboembolic complications, cerebrovascular accidents, or major bleeding on oral anticoagulation. Left ventricular dilatation before aortic valve replacement was present in 20 of 30 patients but normalized in all but 4 patients on follow-up. Most patients showed a normal end-diastolic volume on magnetic resonance imaging, and 23 of 26 patients showed a normal left ventricular ejection fraction (median, 0.53; range, 0.33 to 0.75). Peak systolic strain of the left ventricular myocardium was a median of -13.3% (range, -0.5% to -31%), and was normal in 28 of 30 patients. CONCLUSIONS: Aortic valve replacement in children and young adults offers a good treatment option and may lead to normalization of left ventricular size and function in most patients.