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Atrioventricular valve regurgitation at diagnosis in single-ventricle patients: does it affect longitudinal outcomes?

Published online by Cambridge University Press:  19 September 2013

Jason M. Garnreiter*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
Lloyd Y. Tani
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
Hsin-Yi Weng
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
Xiaoming Sheng
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
Nelangi M. Pinto
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
*
Correspondence to: J. Garnreiter, MD, St. Louis University, 1465 S. Grand Blvd, St. Louis, MO 63141. Tel: 314-577-5633; Fax: 314-268-4035; E-mail: Garnreiterjm@slu.edu

Abstract

Introduction

Significant atrioventricular valve regurgitation at diagnosis in single-ventricle patients has been associated with mortality and morbidity. However, longitudinal data on the effect of valve regurgitation at diagnosis on outcomes in the era of surgical valve interventions are scarce.

Materials and methods

This is a retrospective review of single-ventricle patients admitted to a regional centre from 2005 to 2008. Data were reviewed from birth to 18 months, and association of atrioventricular valve regurgitation at diagnosis with mortality and morbidity was evaluated.

Results

A total of 118 patients were studied, 73% with a single right ventricle. At diagnosis, 37 patients (31%) had mild, 5 (4%) had mild to moderate, and 4 (3%) had ≥ moderate atrioventricular valve regurgitation. Moderate or greater valve regurgitation was associated with mortality (HR 5.51, 95% CI 1.24–24.61, p = 0.025), and all four patients with ≥ moderate valve regurgitation died. However, valve regurgitation was not associated with mortality for left ventricle patients. In all, 12 patients (10%) had surgical atrioventricular valve interventions. There were no independent predictors of valve intervention, and no patient having an intervention had > mild valve regurgitation at diagnosis. There was no association between valve regurgitation and days of hospitalisation or chest tube drainage.

Conclusion

Significant atrioventricular valve regurgitation at diagnosis remains a risk factor for mortality in single-ventricle patients, although it may be less important for single left ventricle patients. However, it is not associated with increased morbidity or surgical atrioventricular valve intervention in survivors. Reliably predicting surgical atrioventricular valve intervention remains a challenge in single-ventricle patients.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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