Skip to main content

Advertisement

SpringerLink
Log in

Echocardiographic Follow-Up of Congenital Aortic Valvular Stenosis

  • ORIGINAL ARTICLE
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

We investigated the morphology of the stenotic aortic valve, the progression of the stenosis, and the onset and progression of aortic regurgitation (AR) in patients with congenital aortic valvular stenosis (AVS). The medical records of 278 patients with AVS were reviewed, with the patients with concomitant lesions besides AR excluded. Very mild aortic stenosis was defined as a transvalvular Doppler peak systolic instantaneous gradient (PSIG) less than 25 mmHg, mild stenosis as 25–49 mmHg, moderate stenosis as 50–75 mmHg, and severe stenosis as more than 75 mmHg. The mean age of the patients was 4.9 ± 4.3 years (range, 3 days to 15 years), and 203 (73%) were male. The number of the cusps was determined with two-dimensional echocardiography in 266 patients (95%): unicuspid in 3 patients (1%), bicuspid in 127 patients (48%), and tricuspid in 136 patients (51%). A total of 192 of all patients were followed for 2 months to 14.6 years (mean 4.2 ± 3.3 years) with medical treatment alone. Among 72 patients with very mild stenosis at initial echocardiographic examination, 20% had mild, 3% moderate, and 1% severe stenosis after a mean period of 3.7 years. In 70 patients with mild stenosis at initial echocardiographic examination, 28% had moderate and 9% severe stenosis after a mean period of 5 years. Among 44 patients with moderate stenosis at initial echocardiographic examination, 36% had severe stenosis after a mean period of 3.7 years. Among 192 patients, 40% had AR (3% trivial, 28% mild, and 9% moderate) at initial echocardiographic examination. After a mean period of 4.2 years, 58% of the patients had AR (13 % trivial, 25% mild, 16% moderate, and 4% severe). There was not statistically significant difference between catheterization peak systolic gradients (47 ± 16 mmHg) and Doppler estimated mean gradients (45 ± 9 mmHg) (p = 0.53), whereas Doppler PSIGs (74.9 ± 15.7 mmHg) were higher than catheterization peak systolic gradients (p < 0.0001) in 25 patients who were studied in the catheterization lab. Patients with very mild stenosis may be followed with a noninvasive approach every 1 or 2 years, and an annual follow-up is suggested for patients with mild stenosis. Nearly one-third of patients with moderate stenosis at initial echocardiographic examination had severe stenosis after a mean period of 3.7 years. Therefore, we recommend, that patients with moderate stenosis undergo noninvasive evaluation every 6 months. Doppler estimated mean gradient is very useful in predicting the need for intervention in children with AVS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Barker PCA, Ensing G, Ludomirsky A, et al. (2002) Comparison of simultaneous invasive and noninvasive measurements of pressure gradients in congenital aortic valve stenosis. J Am Soc Echocardiogr 15:1496–1502

    Article  PubMed  Google Scholar 

  2. Baumgartner H, Kratzer H, Helmreich G, Kühn P (1988) Quantification of aortic regurgitation by color coded cross-sectional Doppler echocardiography. J Am Soc Echocardiogr 9:380–387

    CAS  Google Scholar 

  3. Baumgartner H, Stefenelli T, Nisderberger J, Schima H, Maurer G (1999) Overestimation of catheter gradients in patients with aortic stenosis: a predictable manifestation of pressure recovery. J Am Coll Cardiol 33:1655–1661

    Article  PubMed  CAS  Google Scholar 

  4. Bengur AR, Snider AR, Serwer GA, et al. (1989) Usefulness of the Doppler mean gradient in evaluation of children with aortic valve stenosis and comparison to gradient at catheterization. Am J Cardiol 64:756–761

    Article  PubMed  CAS  Google Scholar 

  5. Bonow RO, Carabello B, de Leon AC, et al. (1998) ACC/AHA 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 (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol 32:1486–1588

    Article  Google Scholar 

  6. Horstkqtte D, Loogen F (1988) The natural history of aortic valvular stenosis. Eur Heart J 9:57–64

    Google Scholar 

  7. Karamlou T, Shen I, Alsoufia B, et al. (2005) The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children: 30 year results from a single institution. Eur J Cardiothorac Surg. 27:81–85

    Article  PubMed  Google Scholar 

  8. Keane JF, Driscoll DJ, Gersony WM, et al. (1993) Second natural history study of congenital heart defects. Results of treatment of patients with aortic valvar stenosis. Circulation 87:16–27

    Google Scholar 

  9. Kiraly P, Kapusta L, van Lier H, et al. (1997) Natural history of congenital aortic valvar stenosis: an echo and Doppler cardiographic study. Cardiol Young 7:188–193

    Article  Google Scholar 

  10. Krafchek J, Robertson JH, Raclford M, Adams D, Kisslo J (1985) A reconsideration of Doppler assessed gradients in suspected aortic stenosis. Am Heart J 110:765–773

    Article  PubMed  CAS  Google Scholar 

  11. Latson LA (1990) Aortic stenosis: valvular, supravalvular, and fibromuscular Subralvular In: Garson A, Bricker JT, McNamara DG (eds) The Science and Practice of Pediatric Cardiology. Lea & Febiger, Philadelphia, pp 1134–1352

    Google Scholar 

  12. Lebofgne L, Tribouilloy C, Otmani A, et al. (1998) Comparative value of Doppler echocardiography and cardiac catheterization in the decision to operate on patients with aortic stenosis. Int J Cardiol 65:163–168

    Article  Google Scholar 

  13. Lemler MS, Valdes-Cruz LM, Shandas RS, et al. (1999) Insights into catheter/Doppler discrepancies in congenital aortic stenosis. Am J Cardiol 83:1447–1450

    Article  PubMed  CAS  Google Scholar 

  14. Lofland GK, McCrinclle BW, Williams WG, et al. (2001) Critical aortic stenosis in the neonate: a multiinstitutional study of management, outcomes, and risk factors. J Thorac Cardiovasc Surg 121:10–27

    Article  PubMed  CAS  Google Scholar 

  15. Mack G, Silberbach M (2000) Aortic and pulmonary stenosis. Pediatr Rev 21:79–85

    PubMed  CAS  Google Scholar 

  16. Miyatake K, Okamoto M, Kinoshita M, et al. (1984) Clinical applications of a new type of real-time two-dimensional Doppler flow imaging system. Am J Cardiol 54:857–868

    Article  PubMed  CAS  Google Scholar 

  17. Nishimura RA, Pieroni DR, Bierman FZ, et al. (1993) Second natural history study of congenital heart defects. Aortic stenosis: echocardiography. Results of treatment of patients with aortic valvar stenosis. Circulation 87:66–72

    Google Scholar 

  18. Omoto KR, Yokote Y, Takamoto S, et al. (1984) The development of real-time two-dimensional Doppler echocardiography and its clinical significance in acquired valvular diseases. Jpn Heart J 25:325–340

    PubMed  CAS  Google Scholar 

  19. Penn IM, Dumesnil JG (1988) A new and simple method to measure maximal aortic valve pressure gradients by Doppler echocardiography. Am J Cardiol 61:382–385

    Article  PubMed  CAS  Google Scholar 

  20. Perry GJ, Helmcke F, Nanda NC, Byard C, Soto B (1987) Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol 9:952–959

    Article  PubMed  CAS  Google Scholar 

  21. Samanek M, Voriskova M (1999) Congenital heart disease among 815,569 children born between 1980 and 1990 and their 15-year survival; a prospective Bohemia survival study. Pediatr Cardiol 20:411–417

    Article  PubMed  CAS  Google Scholar 

  22. Sanyal SK (1995) Aortic regurgitation. In: Emmanouilides GC, Allen HD, Riemenschneider TA, Gutgesell HP (eds) Heart Disease In Infants, Children and Adolescents including the Fetus and Young Adult. Williams & Wilkins, Baltimore, pp 1429–1440

    Google Scholar 

  23. Stout KK, Otto CM (2003) Quantification of valvular aortic stenosis. J Am Coll Cardiol 2:54–58

    Google Scholar 

  24. Switzer DF, Yoganathan AP, Nanda NC, Woo YR, Ridgway AJ (1987) Calibration of color flow Doppler mapping during extreme hemodynamic conditions in vitro: a foundation for a reliable quantitative grading system for aortic incompetence. Circulation 75:837–846

    PubMed  CAS  Google Scholar 

  25. Tohyama K, Satomi G, Momma K (1997) Aortic valve prolapse and aortic regurgitation associated with subpulmonic ventricular septal defect. Am J Cardiol 79:1285–1289

    Article  PubMed  CAS  Google Scholar 

  26. Ward C (2000) Clinical significance of the bicuspid aortic valve. Heart 83:81–85

    Article  PubMed  CAS  Google Scholar 

  27. Wilkenshoff UM, Kruck I, Gast D, Schröder R (1994) Validity of continuous wave Doppler and colour Doppler in the assessment of aortic regurgitation. Eur Heart J 15:1227–1234

    PubMed  CAS  Google Scholar 

  28. Wolf D, Daniels O (2002) Management of valvar aortic stenosis in children. Pediatr Cardiol 23:375–377

    Article  PubMed  Google Scholar 

  29. Zhang Y, Nttter-Hauge S, Ihlen H, et al. (1986) Noninvasive evaluation of aortic regurgitation by Doppler echocardiography. Br Heart J 55:32–38

    PubMed  CAS  Google Scholar 

Download references

Acknowledgement

This work was supported by Research Fund of Istanbul University grant UDP-612/02082005.

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Istanbul University Cerrahpaşa Medical Faculty, 80303, Aksaray, Istanbul, Turkey

    Ayse Guler Eroglu, Kadir Babaoglu, Leven Saltık, Funda Oztunç, Tevfik Demir, Gulay Ahunbay & Alper Guzeltas

  2. Istanbul University Institute of Cardiology, 80303, Aksaray, Istanbul, Turkey

    Gürkan Çetin

Authors
  1. Ayse Guler Eroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kadir Babaoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leven Saltık
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Funda Oztunç
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tevfik Demir
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gulay Ahunbay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alper Guzeltas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gürkan Çetin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ayse Guler Eroglu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eroglu, A.G., Babaoglu, K., Saltık, L. et al. Echocardiographic Follow-Up of Congenital Aortic Valvular Stenosis. Pediatr Cardiol 27, 713–719 (2006). https://doi.org/10.1007/s00246-006-1321-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-006-1321-4

Keywords

Search

Navigation