Aortic Valve Morphology Correlates With Left Ventricular Systolic Function and Outcome in Children With Congenital Aortic Stenosis Prior to Balloon Aortic Valvuloplasty

J Invasive Cardiol. 2016 Sep;28(9):381-8.


Objectives: We sought to determine the relationship between aortic valve morphology and left ventricular (LV) systolic function in children with aortic stenosis (AS) prior to balloon aortic valvuloplasty (BAV).

Background: Both aortic valve morphology and LV systolic function have been linked with outcomes in children with congenital AS undergoing BAV. The relationship between aortic valve morphology and LV function is poorly defined despite their importance in regard to outcomes.

Methods: We performed a retrospective multicenter cohort study of 89 AS patients who underwent BAV between 2007-2013. Pre-BAV echocardiograms were analyzed for: aortic valve opening (AVO); aortic valve type (true bicuspid, functionally bicuspid, or unicuspid); maximal raphe length; aortic valve leaflet symmetry; and valve angle of excursion. The primary endpoint was low function, defined as LV shortening fraction (LVSF) <28%.

Results: Median patient age was 0.17 years (interquartile range [IQR], 0.10-10.74 years) and the median aortic valve mean gradient was 47.00 mm Hg (IQR, 36.75-56.00 mm Hg). Multivariate analysis demonstrated that low AVO (P=.03) was associated with reduced LV function, independent of age or aortic valve gradient (R² = .652). Bicuspid aortic valve (P=.07) was associated with improved LV function compared with functionally unicuspid aortic valve. Low AVO <0.10 was associated with higher adverse outcome.

Conclusion: LV systolic function is most significantly influenced by degree of valve stenosis. Qualitative aspects such as valve type may also affect LV systolic function. Further study may elucidate whether aortic valve morphology or LV function is the principal predictor of response to BAV and of late outcomes after BAV.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Age Factors
  • Aortic Valve / abnormalities*
  • Aortic Valve / diagnostic imaging
  • Aortic Valve Stenosis / congenital*
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / therapy*
  • Balloon Valvuloplasty / methods*
  • Balloon Valvuloplasty / mortality
  • Child
  • Child, Preschool
  • Cohort Studies
  • Echocardiography, Doppler
  • Female
  • Heart Valve Diseases / diagnostic imaging
  • Heart Valve Diseases / therapy*
  • Humans
  • Infant
  • Infant, Newborn
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Statistics, Nonparametric
  • Stroke Volume*
  • Survival Rate
  • Systole
  • Treatment Outcome
  • Ventricular Function, Left / physiology*
  • Young Adult

Supplementary concepts

  • Bicuspid Aortic Valve