P1006Progression of aortic valve dysfunction in adult post-coarctectomy patients


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Abstract

Purpose: Little is known on the progression of aortic valve dysfunction in adult post-coarctectomy patients (CoA). The high prevalence of bicuspid aortic valve (BAV) in CoA is associated with aortic valve stenosis (AS), aortic valve regurgitation (AR), and ascending aortic dilatation. The aim of this study was to evaluate the progression of-, and predictors for aortic valve dysfunction in CoA.Methods: In this prospective study 96 CoA patients underwent serial echocardiographic examinations between 2001 and 2009. AS was defined as maximal aortic valve gradient ≥ 20 mmHg. AR was defined as none and minor, or moderate to severe. Aortic dilatation was defined as an ascending aortic diameter ≥ 35mm.Results: Ninety-six patients (mean age 29.4 years, range 17-61years; male 57%) were followed during a follow-up of 6.8±1.4 years. Sixty patients (63%) had BAV. At baseline aortic dilatation was present in 17 patients (17%, 16with BAV), AS was present in 10 patients (10%, 9 with BAV) and moderate to severe AR was found in 6 patients (6%, of which 3 with BAV and AS). At the end of follow-up AS was present in 15 patients (15%, 13 with BAV) and AR waspresent in 12 patients (13%, of which 8 with BAV, and 6 with BAV and AS). The mean AS progression during follow-up, was 3 mmHg (range -10 – 32 mmHg) (meanbaseline gradient 35±15.1 mmHg vs 38±11.1 mmHg at follow-up). Predictors for the progression rate of AS during follow-up were age (β= 0.20, P= 0.008), aortic dilatation(β= 5.09, P= 0.004), and baseline aortic valve gradient (β= 0.93, P< 0.001).Conclusion: Overall progression of aortic stenosis in patients after coarctation repair is rather mild in this young population. Progression of aortic stenosis in patients after coarctation repair is determined by older age, aortic dilatationand aortic valve gradient at baseline. These findings point towards a common embryological pathway of both valvular and aortic disease in coarctation patients.

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