Pediatric Aortic Valve Insufficiency Follow-up

Updated: Jan 04, 2016
  • Author: Mohsen Saidinejad, MD, MPH, MBA; Chief Editor: Stuart Berger, MD  more...
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Follow-up

Further Outpatient Care

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  • 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.

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Further Inpatient Care

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  • 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. [15]

  • 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.

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Deterrence/Prevention

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  • 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.

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Prognosis

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  • The prognosis largely depends on how accurately the aortic valve insufficiency is characterized and how well the aortic valve insufficiency is then managed. [16]

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Patient Education

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  • Because of the complexity of management, detailed education is required for parents and, if applicable, the patient.

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