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Neo-aortic valvar function after the arterial switch

Published online by Cambridge University Press:  20 September 2006

Bradley S. Marino
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Pediatrics, Pennsylvania, United States of America From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Anesthesia and Critical Care Medicine, Pennsylvania, United States of America
Gil Wernovsky
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Pediatrics, Pennsylvania, United States of America
Doff B. McElhinney
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Pediatrics, Pennsylvania, United States of America
Abbas Jawad
Affiliation:
Department of Biostatistics at the Children's Hospital of Philadelphia, Pennsylvania, United States of America
Dieuwertje L. Kreb
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Pediatrics, Pennsylvania, United States of America
Suzan F. Mantel
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Pediatrics, Pennsylvania, United States of America
Wendy L. van der Woerd
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Pediatrics, Pennsylvania, United States of America
Danielle Robbers-Visser
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Pediatrics, Pennsylvania, United States of America
Rita Novello
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Pediatrics, Pennsylvania, United States of America
J. William Gaynor
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Surgery at the University of Pennsylvania School of Medicine, Pennsylvania, United States of America
Thomas L. Spray
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Surgery at the University of Pennsylvania School of Medicine, Pennsylvania, United States of America
Meryl S. Cohen
Affiliation:
From the Cardiac Center at the Children's Hospital of Philadelphia and the Department of Pediatrics, Pennsylvania, United States of America

Abstract

Objectives: The purpose of our study was to assess the prevalence and progression, during childhood and adolescence, of dilation of the neo-aortic root, and neo-aortic valvar regurgitation, and to identify risk factors for such dilation and regurgitation, after the arterial switch operation. Methods: We included all patients who had undergone an arterial switch operation at The Children's Hospital of Philadelphia, and had been followed for a minimum of 4 years, and had at least 2 postoperative echocardiograms. Neo-aortic valvar regurgitation was quantitatively assessed, and measurements were made of the neo-aortic root at the level of the basal attachment of the leaflets, mid-sinusal level, and the sinutubular junction. Results: We found 82 patients who satisfied the criterions for inclusion, of whom 52 patients had transposition with an intact ventricular septum, and 30 had either an associated ventricular septal defect or double outlet right ventricle. The median follow-up time was 8.8 years (4.1 to 16.4 years). The neo-aortic valve had been replaced in 1 patient. Of the patients, 3 had moderate, 66 had trivial to mild, and 12 had no neo-aortic valvar regurgitation at their most recent follow-up. The regurgitation had progressed by at least 1 grade in 38 of the 82 patients (46.4%). Neo-aortic dilation was noted at the basal attachment of the leaflets, and at mid-sinusal level, which was out of proportion to somatic growth. Conclusions: At mid-term follow-up, significant neo-aortic valve regurgitation is present in 3.7%, and trivial to mild regurgitation in 81.4% of patients. The regurgitation progressed in almost half of the patients over time. We also noted progressive dilation of the neo-aortic root out of proportion to somatic growth.

Type
Original Article
Copyright
© 2006 Cambridge University Press

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