Mixed Aortic Valve Disease in the Young: Initial Observations
The short-term surgical results for mixed aortic valve disease (MAVD) and the long-term effects on the left ventricle (LV) are unknown. Retrospective review identified patients with at least both moderate aortic stenosis (AS) and aortic regurgitation (AR) before surgical intervention. A one-to-one c...
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| Veröffentlicht in: | Pediatric cardiology 2014-08, Vol.35 (6), p.934-942 |
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| creator | Hill, Allison C. Brown, David W. Colan, Steven D. Gauvreau, Kimberly del Nido, Pedro J. Lock, James E. Rathod, Rahul H. |
| description | The short-term surgical results for mixed aortic valve disease (MAVD) and the long-term effects on the left ventricle (LV) are unknown. Retrospective review identified patients with at least both moderate aortic stenosis (AS) and aortic regurgitation (AR) before surgical intervention. A one-to-one comparison cohort of patients with MAVD not referred for surgical intervention was identified. The 45 patients in this study underwent surgical management for MAVD. A control group of 45 medically managed patients with MAVD also was identified. Both groups had elevated LV end-diastolic volume (EDV), elevated LV mass, a normal LV mass:volume ratio (MVR), and a normal ejection fraction. Both groups had diastolic dysfunction shown by early diastolic pulsed-Doppler mitral inflow/early diastolic tissue Doppler velocity
z
-score. The LV end-diastolic pressure (EDP) was correlated with age (
R
= 0.4;
p
= 0.03) and LV MVR (
R
= 0.4;
p
= 0.03) but not with AS, AR, or the score combining gradient and LV size. As shown by 6- to 12-month postoperative echocardiograms, aortic valve gradients and AR significantly improved (gradient 65 ± 17 to 28 ± 18 mmHg,
p
= 0.01; median regurgitation grade moderate to mild;
p
|
| doi_str_mv | 10.1007/s00246-014-0878-6 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6951795</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A715522103</galeid><sourcerecordid>A715522103</sourcerecordid><originalsourceid>FETCH-LOGICAL-c579t-c72155c1cd0b024507dfa39fdb5b503d80853f0111c3b7525f63a32b20b92173</originalsourceid><addsrcrecordid>eNp9kU9r3DAQxUVpabZpP0AvxdBLL05mJMuyCw0s6Z8EEnIJhZ6ELI83Cl4pleyl_fbV4jQ0UIIOAs3vPd7oMfYW4QgB1HEC4FVdAlYlNKop62dshZXgJbYKn7MVoOIl1JU4YK9SugWABhr5kh3wStYCFF-xT5fuF_XFOsTJ2eK7GXdUfHaJTKLC-WK6oeJHmP3mY3Hu3eTMWFx1ieLOTC749Jq9GMyY6M39fciuv365Pj0rL66-nZ-uL0orVTuVVnGU0qLtocuJJah-MKId-k52EkS_TyUGQEQrOiW5HGphBO84dC1HJQ7ZyWJ7N3db6i35KZpR30W3NfG3DsbpxxPvbvQm7HTdSlStzAYf7g1i-DlTmvTWJUvjaDyFOWmU-dcamZNl9P2CbsxI2vkhZEe7x_Va5S04RxCZOvoPlU9PW2eDp8Hl90cCXAQ2hpQiDQ_pEfS-TL2UqXOZel-mrrPm3b9rPyj-tpcBvgApj_yGor4Nc_S5iSdc_wAvfqdo</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1543285450</pqid></control><display><type>article</type><title>Mixed Aortic Valve Disease in the Young: Initial Observations</title><source>MEDLINE</source><source>SpringerLink</source><creator>Hill, Allison C. ; Brown, David W. ; Colan, Steven D. ; Gauvreau, Kimberly ; del Nido, Pedro J. ; Lock, James E. ; Rathod, Rahul H.</creator><creatorcontrib>Hill, Allison C. ; Brown, David W. ; Colan, Steven D. ; Gauvreau, Kimberly ; del Nido, Pedro J. ; Lock, James E. ; Rathod, Rahul H.</creatorcontrib><description>The short-term surgical results for mixed aortic valve disease (MAVD) and the long-term effects on the left ventricle (LV) are unknown. Retrospective review identified patients with at least both moderate aortic stenosis (AS) and aortic regurgitation (AR) before surgical intervention. A one-to-one comparison cohort of patients with MAVD not referred for surgical intervention was identified. The 45 patients in this study underwent surgical management for MAVD. A control group of 45 medically managed patients with MAVD also was identified. Both groups had elevated LV end-diastolic volume (EDV), elevated LV mass, a normal LV mass:volume ratio (MVR), and a normal ejection fraction. Both groups had diastolic dysfunction shown by early diastolic pulsed-Doppler mitral inflow/early diastolic tissue Doppler velocity
z
-score. The LV end-diastolic pressure (EDP) was correlated with age (
R
= 0.4;
p
= 0.03) and LV MVR (
R
= 0.4;
p
= 0.03) but not with AS, AR, or the score combining gradient and LV size. As shown by 6- to 12-month postoperative echocardiograms, aortic valve gradients and AR significantly improved (gradient 65 ± 17 to 28 ± 18 mmHg,
p
= 0.01; median regurgitation grade moderate to mild;
p
< 0.01), LV EDV normalized, and LV mass significantly improved (
p
< 0.01). Diastolic dysfunction was unchanged. Symptoms did not correlate with any measured parameter, but the preoperative symptoms resolved. In conclusion, despite diastolic dysfunction, systolic function is invariably preserved, and symptoms are not correlated with aortic valve function or LV EDP. Current surgical practice preserves LV mechanics and results in short-term improvement in valve function and symptoms.</description><identifier>ISSN: 0172-0643</identifier><identifier>EISSN: 1432-1971</identifier><identifier>DOI: 10.1007/s00246-014-0878-6</identifier><identifier>PMID: 24563072</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adolescent ; Aortic Valve - diagnostic imaging ; Aortic Valve - physiopathology ; Aortic Valve - surgery ; Aortic valve stenosis ; Bicuspid Aortic Valve Disease ; Boston ; Cardiac Catheterization - adverse effects ; Cardiac Catheterization - methods ; Cardiac Surgery ; Cardiology ; Cardiovascular Surgical Procedures - adverse effects ; Cardiovascular Surgical Procedures - methods ; Echocardiography, Doppler, Pulsed - methods ; Female ; Heart Defects, Congenital - diagnosis ; Heart Defects, Congenital - physiopathology ; Heart Defects, Congenital - surgery ; Heart Valve Diseases - diagnosis ; Heart Valve Diseases - physiopathology ; Heart Valve Diseases - surgery ; Heart Ventricles - pathology ; Heart Ventricles - physiopathology ; Humans ; Male ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Organ Size ; Original Article ; Outcome Assessment, Health Care ; Postoperative Complications - diagnosis ; Postoperative Complications - etiology ; Postoperative Complications - physiopathology ; Retrospective Studies ; Stroke Volume ; Symptom Assessment - methods ; Time Factors ; Vascular Surgery ; Ventricular Dysfunction, Left - diagnosis ; Ventricular Dysfunction, Left - etiology ; Ventricular Dysfunction, Left - physiopathology</subject><ispartof>Pediatric cardiology, 2014-08, Vol.35 (6), p.934-942</ispartof><rights>Springer Science+Business Media New York 2014</rights><rights>COPYRIGHT 2014 Springer</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c579t-c72155c1cd0b024507dfa39fdb5b503d80853f0111c3b7525f63a32b20b92173</citedby><cites>FETCH-LOGICAL-c579t-c72155c1cd0b024507dfa39fdb5b503d80853f0111c3b7525f63a32b20b92173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00246-014-0878-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00246-014-0878-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,777,781,882,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24563072$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hill, Allison C.</creatorcontrib><creatorcontrib>Brown, David W.</creatorcontrib><creatorcontrib>Colan, Steven D.</creatorcontrib><creatorcontrib>Gauvreau, Kimberly</creatorcontrib><creatorcontrib>del Nido, Pedro J.</creatorcontrib><creatorcontrib>Lock, James E.</creatorcontrib><creatorcontrib>Rathod, Rahul H.</creatorcontrib><title>Mixed Aortic Valve Disease in the Young: Initial Observations</title><title>Pediatric cardiology</title><addtitle>Pediatr Cardiol</addtitle><addtitle>Pediatr Cardiol</addtitle><description>The short-term surgical results for mixed aortic valve disease (MAVD) and the long-term effects on the left ventricle (LV) are unknown. Retrospective review identified patients with at least both moderate aortic stenosis (AS) and aortic regurgitation (AR) before surgical intervention. A one-to-one comparison cohort of patients with MAVD not referred for surgical intervention was identified. The 45 patients in this study underwent surgical management for MAVD. A control group of 45 medically managed patients with MAVD also was identified. Both groups had elevated LV end-diastolic volume (EDV), elevated LV mass, a normal LV mass:volume ratio (MVR), and a normal ejection fraction. Both groups had diastolic dysfunction shown by early diastolic pulsed-Doppler mitral inflow/early diastolic tissue Doppler velocity
z
-score. The LV end-diastolic pressure (EDP) was correlated with age (
R
= 0.4;
p
= 0.03) and LV MVR (
R
= 0.4;
p
= 0.03) but not with AS, AR, or the score combining gradient and LV size. As shown by 6- to 12-month postoperative echocardiograms, aortic valve gradients and AR significantly improved (gradient 65 ± 17 to 28 ± 18 mmHg,
p
= 0.01; median regurgitation grade moderate to mild;
p
< 0.01), LV EDV normalized, and LV mass significantly improved (
p
< 0.01). Diastolic dysfunction was unchanged. Symptoms did not correlate with any measured parameter, but the preoperative symptoms resolved. In conclusion, despite diastolic dysfunction, systolic function is invariably preserved, and symptoms are not correlated with aortic valve function or LV EDP. Current surgical practice preserves LV mechanics and results in short-term improvement in valve function and symptoms.</description><subject>Adolescent</subject><subject>Aortic Valve - diagnostic imaging</subject><subject>Aortic Valve - physiopathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic valve stenosis</subject><subject>Bicuspid Aortic Valve Disease</subject><subject>Boston</subject><subject>Cardiac Catheterization - adverse effects</subject><subject>Cardiac Catheterization - methods</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Cardiovascular Surgical Procedures - adverse effects</subject><subject>Cardiovascular Surgical Procedures - methods</subject><subject>Echocardiography, Doppler, Pulsed - methods</subject><subject>Female</subject><subject>Heart Defects, Congenital - diagnosis</subject><subject>Heart Defects, Congenital - physiopathology</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart Valve Diseases - diagnosis</subject><subject>Heart Valve Diseases - physiopathology</subject><subject>Heart Valve Diseases - surgery</subject><subject>Heart Ventricles - pathology</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Organ Size</subject><subject>Original Article</subject><subject>Outcome Assessment, Health Care</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Retrospective Studies</subject><subject>Stroke Volume</subject><subject>Symptom Assessment - methods</subject><subject>Time Factors</subject><subject>Vascular Surgery</subject><subject>Ventricular Dysfunction, Left - diagnosis</subject><subject>Ventricular Dysfunction, Left - etiology</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><issn>0172-0643</issn><issn>1432-1971</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9r3DAQxUVpabZpP0AvxdBLL05mJMuyCw0s6Z8EEnIJhZ6ELI83Cl4pleyl_fbV4jQ0UIIOAs3vPd7oMfYW4QgB1HEC4FVdAlYlNKop62dshZXgJbYKn7MVoOIl1JU4YK9SugWABhr5kh3wStYCFF-xT5fuF_XFOsTJ2eK7GXdUfHaJTKLC-WK6oeJHmP3mY3Hu3eTMWFx1ieLOTC749Jq9GMyY6M39fciuv365Pj0rL66-nZ-uL0orVTuVVnGU0qLtocuJJah-MKId-k52EkS_TyUGQEQrOiW5HGphBO84dC1HJQ7ZyWJ7N3db6i35KZpR30W3NfG3DsbpxxPvbvQm7HTdSlStzAYf7g1i-DlTmvTWJUvjaDyFOWmU-dcamZNl9P2CbsxI2vkhZEe7x_Va5S04RxCZOvoPlU9PW2eDp8Hl90cCXAQ2hpQiDQ_pEfS-TL2UqXOZel-mrrPm3b9rPyj-tpcBvgApj_yGor4Nc_S5iSdc_wAvfqdo</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Hill, Allison C.</creator><creator>Brown, David W.</creator><creator>Colan, Steven D.</creator><creator>Gauvreau, Kimberly</creator><creator>del Nido, Pedro J.</creator><creator>Lock, James E.</creator><creator>Rathod, Rahul H.</creator><general>Springer US</general><general>Springer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140801</creationdate><title>Mixed Aortic Valve Disease in the Young: Initial Observations</title><author>Hill, Allison C. ; Brown, David W. ; Colan, Steven D. ; Gauvreau, Kimberly ; del Nido, Pedro J. ; Lock, James E. ; Rathod, Rahul H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c579t-c72155c1cd0b024507dfa39fdb5b503d80853f0111c3b7525f63a32b20b92173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Aortic Valve - diagnostic imaging</topic><topic>Aortic Valve - physiopathology</topic><topic>Aortic Valve - surgery</topic><topic>Aortic valve stenosis</topic><topic>Bicuspid Aortic Valve Disease</topic><topic>Boston</topic><topic>Cardiac Catheterization - adverse effects</topic><topic>Cardiac Catheterization - methods</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Cardiovascular Surgical Procedures - adverse effects</topic><topic>Cardiovascular Surgical Procedures - methods</topic><topic>Echocardiography, Doppler, Pulsed - methods</topic><topic>Female</topic><topic>Heart Defects, Congenital - diagnosis</topic><topic>Heart Defects, Congenital - physiopathology</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart Valve Diseases - diagnosis</topic><topic>Heart Valve Diseases - physiopathology</topic><topic>Heart Valve Diseases - surgery</topic><topic>Heart Ventricles - pathology</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Organ Size</topic><topic>Original Article</topic><topic>Outcome Assessment, Health Care</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Retrospective Studies</topic><topic>Stroke Volume</topic><topic>Symptom Assessment - methods</topic><topic>Time Factors</topic><topic>Vascular Surgery</topic><topic>Ventricular Dysfunction, Left - diagnosis</topic><topic>Ventricular Dysfunction, Left - etiology</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hill, Allison C.</creatorcontrib><creatorcontrib>Brown, David W.</creatorcontrib><creatorcontrib>Colan, Steven D.</creatorcontrib><creatorcontrib>Gauvreau, Kimberly</creatorcontrib><creatorcontrib>del Nido, Pedro J.</creatorcontrib><creatorcontrib>Lock, James E.</creatorcontrib><creatorcontrib>Rathod, Rahul H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hill, Allison C.</au><au>Brown, David W.</au><au>Colan, Steven D.</au><au>Gauvreau, Kimberly</au><au>del Nido, Pedro J.</au><au>Lock, James E.</au><au>Rathod, Rahul H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mixed Aortic Valve Disease in the Young: Initial Observations</atitle><jtitle>Pediatric cardiology</jtitle><stitle>Pediatr Cardiol</stitle><addtitle>Pediatr Cardiol</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>35</volume><issue>6</issue><spage>934</spage><epage>942</epage><pages>934-942</pages><issn>0172-0643</issn><eissn>1432-1971</eissn><abstract>The short-term surgical results for mixed aortic valve disease (MAVD) and the long-term effects on the left ventricle (LV) are unknown. Retrospective review identified patients with at least both moderate aortic stenosis (AS) and aortic regurgitation (AR) before surgical intervention. A one-to-one comparison cohort of patients with MAVD not referred for surgical intervention was identified. The 45 patients in this study underwent surgical management for MAVD. A control group of 45 medically managed patients with MAVD also was identified. Both groups had elevated LV end-diastolic volume (EDV), elevated LV mass, a normal LV mass:volume ratio (MVR), and a normal ejection fraction. Both groups had diastolic dysfunction shown by early diastolic pulsed-Doppler mitral inflow/early diastolic tissue Doppler velocity
z
-score. The LV end-diastolic pressure (EDP) was correlated with age (
R
= 0.4;
p
= 0.03) and LV MVR (
R
= 0.4;
p
= 0.03) but not with AS, AR, or the score combining gradient and LV size. As shown by 6- to 12-month postoperative echocardiograms, aortic valve gradients and AR significantly improved (gradient 65 ± 17 to 28 ± 18 mmHg,
p
= 0.01; median regurgitation grade moderate to mild;
p
< 0.01), LV EDV normalized, and LV mass significantly improved (
p
< 0.01). Diastolic dysfunction was unchanged. Symptoms did not correlate with any measured parameter, but the preoperative symptoms resolved. In conclusion, despite diastolic dysfunction, systolic function is invariably preserved, and symptoms are not correlated with aortic valve function or LV EDP. Current surgical practice preserves LV mechanics and results in short-term improvement in valve function and symptoms.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>24563072</pmid><doi>10.1007/s00246-014-0878-6</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Pediatric cardiology, 2014-08, Vol.35 (6), p.934-942 |
| issn | 0172-0643 1432-1971 |
| language | eng |
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| source | MEDLINE; SpringerLink |
| subjects | Adolescent Aortic Valve - diagnostic imaging Aortic Valve - physiopathology Aortic Valve - surgery Aortic valve stenosis Bicuspid Aortic Valve Disease Boston Cardiac Catheterization - adverse effects Cardiac Catheterization - methods Cardiac Surgery Cardiology Cardiovascular Surgical Procedures - adverse effects Cardiovascular Surgical Procedures - methods Echocardiography, Doppler, Pulsed - methods Female Heart Defects, Congenital - diagnosis Heart Defects, Congenital - physiopathology Heart Defects, Congenital - surgery Heart Valve Diseases - diagnosis Heart Valve Diseases - physiopathology Heart Valve Diseases - surgery Heart Ventricles - pathology Heart Ventricles - physiopathology Humans Male Medical research Medicine Medicine & Public Health Medicine, Experimental Organ Size Original Article Outcome Assessment, Health Care Postoperative Complications - diagnosis Postoperative Complications - etiology Postoperative Complications - physiopathology Retrospective Studies Stroke Volume Symptom Assessment - methods Time Factors Vascular Surgery Ventricular Dysfunction, Left - diagnosis Ventricular Dysfunction, Left - etiology Ventricular Dysfunction, Left - physiopathology |
| title | Mixed Aortic Valve Disease in the Young: Initial Observations |
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