Pediatric Aortic Valve Insufficiency Follow-up
- Author: Mohsen Saidinejad, MD, MPH, MBA; Chief Editor: Stuart Berger, MD more...
Further Outpatient Care
See the list below:
- Patients with chronic aortic regurgitation usually do not become symptomatic until after the development of myocardial dysfunction.
- Surgical treatment often does not restore normal LV function.
- In patients with severe aortic regurgitation, careful clinical follow-up and noninvasive testing with echocardiography at approximately 6-month intervals are necessary for correct timing of surgical intervention (after the onset of LV dysfunction but before the development of severe symptoms).
- Lack of symptoms and normal LV function indicate that surgery can be delayed.
- Surgery should be considered for asymptomatic patients with progressive LV dysfunction and an LV ejection fraction less than 0.50, an LV or end-systolic volume higher than 55 mL/m2, or an end-systolic diameter longer than 55 mm.
- An echocardiographic evaluation should be performed in asymptomatic patients with known aortic regurgitation, looking for signs of development of LV dysfunction.
Further Inpatient Care
See the list below:
- Most inpatient follow-up care relates to symptomatic aortic valve insufficiency that has warranted valve replacement.
- Aortic valve replacement for aortic regurgitation (AR), in patients with severe aortic regurgitation and symptoms of heart failure, improves the patient's survival rate and quality of life.
- In asymptomatic patients with impaired left ventricular (LV) function, valve replacement prevents a decrease in LV function.
- In asymptomatic patients, if surgery is performed soon after recognition of ventricular dysfunction, the postoperative outcome is good in terms of survival rate and restoration of a normal ventricular function.
See the list below:
- Prevention of infective endocarditis is of major importance. Studious attention to dental hygiene is of paramount importance in reducing the chances of an endocarditis episode.
- The goal is to preserve normal LV function and volume and to prevent development of symptoms of heart failure.
See the list below:
- The prognosis largely depends on how accurately the aortic valve insufficiency is characterized and how well the aortic valve insufficiency is then managed.
See the list below:
- Because of the complexity of management, detailed education is required for parents and, if applicable, the patient.
Hanedan Onan S, Baykan A, Sezer S, et al. Evaluation of Cardiovascular Changes in Children with BAVs. Pediatr Cardiol. 2015 Nov 20. [Medline].
Gentles TL, Colan SD, Wilson NJ, et al. Left ventricular mechanics during and after acute rheumatic fever: contractile dysfunction is closely related to valve regurgitation. J Am Coll Cardiol. 2001 Jan. 37(1):201-7. [Medline].
Lowenthal A, Tacy TA, Behzadian F, Punn R. Echocardiographic predictors of early postsurgical myocardial dysfunction in pediatric patients with aortic valve insufficiency. Pediatr Cardiol. 2013 Aug. 34(6):1335-43. [Medline].
[Guideline] Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008 Oct 7. 118(15):e523-661. [Medline].
Scognamiglio R, Rahimtoola SH, Fasoli G, et al. Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med. 1994 Sep 15. 331(11):689-94. [Medline].
Pasquali SK, Shera D, Wernovsky G, et al. Midterm outcomes and predictors of reintervention after the Ross procedure in infants, children, and young adults. J Thorac Cardiovasc Surg. 2007 Apr. 133(4):893-9. [Medline].
Kouchoukos NT, Masetti P, Nickerson NJ, et al. The Ross procedure: long-term clinical and echocardiographic follow-up. Ann Thorac Surg. 2004 Sep. 78(3):773-81; discussion 773-81. [Medline].
Brancaccio G, Polito A, Hoxha S, Gandolfo F, Giannico S, Amodeo A, et al. The Ross procedure in patients aged less than 18 years: The midterm results. J Thorac Cardiovasc Surg. 2013 Mar 12. [Medline].
Elkins RC, Lane MM, McCue C. Ross operation in children: late results. J Heart Valve Dis. 2001 Nov. 10(6):736-41. [Medline].
Lupinetti FM, Duncan BW, Lewin M, Dyamenahalli U, Rosenthal GL. Comparison of autograft and allograft aortic valve replacement in children. J Thorac Cardiovasc Surg. 2003 Jul. 126(1):240-6. [Medline].
Elkins RC, Knott-Craig CJ, McCue C, Lane MM. Congenital aortic valve disease. Improved survival and quality of life. Ann Surg. 1997 May. 225(5):503-10; discussion 510-1. [Medline].
Luciani GB, Favaro A, Casali G, Santini F, Mazzucco A. Ross operation in the young: a ten-year experience. Ann Thorac Surg. 2005 Dec. 80(6):2271-7. [Medline].
Takkenberg JJ, van Herwerden LA, Eijkemans MJ, Bekkers JA, Bogers AJ. Evolution of allograft aortic valve replacement over 13 years: results of 275 procedures. Eur J Cardiothorac Surg. 2002 Apr. 21(4):683-91; discussion 691. [Medline].
[Guideline] Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9. 116(15):1736-54. [Medline].
Cox DA, Walton K, Bartz PJ, Tweddell JS, Frommelt PC, Earing MG. Predicting left ventricular recovery after replacement of a regurgitant aortic valve in pediatric and young adult patients: is it ever too late?. Pediatr Cardiol. 2013 Mar. 34(3):694-9. [Medline].
d'Udekem Y, Siddiqui J, Seaman CS, Konstantinov IE, Galati JC, Cheung MM, et al. Long-term results of a strategy of aortic valve repair in the pediatric population. J Thorac Cardiovasc Surg. 2013 Feb. 145(2):461-7; discussion 467-9. [Medline].
Bolen JL, Alderman EL. Hemodynamic consequences of afterload reduction in patients with chronic aortic regurgitation. Circulation. 1976 May. 53(5):879-83. [Medline].
Bonow RO, Carabello B, de Leon AC, et al. ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Val. J Heart Valve Dis. 1998 Nov. 7(6):672-707. [Medline].
Bonow RO, Dodd JT, Maron BJ, et al. Long-term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitation. Circulation. 1988 Nov. 78(5 Pt 1):1108-20. [Medline].
Bonow RO, Rosing DR, Maron BJ, et al. Reversal of left ventricular dysfunction after aortic valve replacement for chronic aortic regurgitation: influence of duration of preoperative left ventricular dysfunction. Circulation. 1984 Oct. 70(4):570-9. [Medline].
Braunwald. Heart Disease: A Textbook of Cardiovascular Medicine. 1997. Vol 1: 1045-60.
Cameron DE. Surgical techniques. Ascending aorta. Cardiol Clin. 1999 Nov. 17(4):739-50. [Medline].
Carabello BA. Vasodilators in aortic regurgitation--where is the evidence of their effectiveness?. N Engl J Med. 2005 Sep 29. 353(13):1400-2. [Medline].
Carabello BA, Crawford FA Jr. Valvular heart disease. N Engl J Med. 1997 Jul 3. 337(1):32-41. [Medline].
David TE, Ivanov J, Armstrong S, Feindel CM, Webb GD. Aortic valve-sparing operations in patients with aneurysms of the aortic root or ascending aorta. Ann Thorac Surg. 2002 Nov. 74(5):S1758-61; discussion S1792-9. [Medline].
Ekery DL, Davidoff R. Aortic regurgitation: quantitative methods by echocardiography. Echocardiography. 2000 Apr. 17(3):293-302. [Medline].
Elkins RC. The Ross operation: applications to children. Semin Thorac Cardiovasc Surg. 1996 Oct. 8(4):345-9. [Medline].
Fedderly RT. Left ventricular outflow obstruction. Pediatr Clin North Am. 1999 Apr. 46(2):369-84. [Medline].
Fioretti P, Benussi B, Scardi S, et al. Afterload reduction with nifedipine in aortic insufficiency. Am J Cardiol. 1982 May. 49(7):1728-32. [Medline].
Grande KJ, Cochran RP, Reinhall PG, Kunzelman KS. Mechanisms of aortic valve incompetence: finite element modeling of aortic root dilatation. Ann Thorac Surg. 2000 Jun. 69(6):1851-7. [Medline].
Greenberg BH, DeMots H, Murphy E, Rahimtoola S. Beneficial effects of hydralazine on rest and exercise hemodynamics in patients with chronic severe aortic insufficiency. Circulation. 1980 Jul. 62(1):49-55. [Medline].
Grocott-Mason RM, Lund O, Elwidaa H, et al. Long-term results after aortic valve replacement in patients with congestive heart failure. Homografts vs prosthetic valves. Eur Heart J. 2000 Oct. 21(20):1698-707. [Medline].
Harris KM, Malenka DJ, Haney MF, et al. Improvement in mitral regurgitation after aortic valve replacement. Am J Cardiol. 1997 Sep 15. 80(6):741-5. [Medline].
Ismailov RM, Weiss HB, Ness RB, et al. Blunt cardiac injury associated with cardiac valve insufficiency: trauma links to chronic disease?. Injury. 2005 Sep. 36(9):1022-8. [Medline].
Katz NM. Current surgical treatment of valvular heart disease. Am Fam Physician. 1995 Aug. 52(2):559-68. [Medline].
Levine HJ, Gaasch WH. Vasoactive drugs in chronic regurgitant lesions of the mitral and aortic valves. J Am Coll Cardiol. 1996 Nov 1. 28(5):1083-91. [Medline].
Pasquali SK, Cohen MS, Shera D, et al. The relationship between neo-aortic root dilation, insufficiency, and reintervention following the Ross procedure in infants, children, and young adults. J Am Coll Cardiol. 2007 May 1. 49(17):1806-12. [Medline].
Shah PM, Graham BM. Management of aortic stenosis: is cardiac catheterization necessary?. Am J Cardiol. 1991 May 1. 67(11):1031-2. [Medline].
Shiota T, Jones M, Aida S, et al. Calculation of aortic regurgitant volume by a new digital Doppler color flow mapping method: an animal study with quantified chronic aortic regurgitation. J Am Coll Cardiol. 1997 Sep. 30(3):834-42. [Medline].