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Left Ventricular Strain Normalizes After Balloon Aortic Valvuloplasty in Infants with Congenital Aortic Stenosis

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Abstract

Severe aortic stenosis (AS) causes left ventricular (LV) afterload and subendocardial ischemia. Despite this, most infants with AS have normal LV ejection fraction (EF). Strain analysis using two-dimensional speckle tracking echocardiography (2DSTE) may identify more sensitive markers of systolic dysfunction. We sought to show changes in LV strain after balloon aortic valvuloplasty (BAV) in infants with AS. Twenty-seven infants ≤ 1 year of age with AS who underwent BAV from 2007 to 2017 were included. Echocardiograms before/after BAV were retrospectively analyzed with 2DSTE. Median age was 29 days (interquartile range 3–52) and LV EF was 64 ± 10%. Global longitudinal strain (GLS) significantly improved post-BAV (− 17 ± 5 vs. − 20 ± 4%, p = 0.001) with no difference in global circumferential strain. Peak longitudinal strain was abnormal at the inferoseptal base and mid-ventricle (− 15 ± 6 and − 17 ± 5 = 7%, respectively) and significantly improved in the basal and mid-anterolateral segments (− 17 ± 5 vs. − 21 ± 5%, p < 0.01; − 17 ± 6% vs. − 20 ± 5%, p = 0.01, respectively). Five (20%) patients underwent reintervention, and had significantly higher peak-to-peak pre and post-BAV AS gradients (86 ± 14 vs. 61 ± 20 mmHg, p = 0.02; 33 ± 17 vs. 21 ± 10 mmHg, p = 0.04, respectively). In conclusion, longitudinal strain is abnormal in infants with AS and improves to previously published normal values after BAV.

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Acknowledgements

This study was funded by the Andrew King Award, a grant awarded by Colin’s Kids Inc. This funding source had no involvement in study design, nor in the collection, analysis and interpretation of data.

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  1. Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, CHN 2-253, New York, NY, 10032, USA

    Ashish A. Ankola, Michael P. DiLorenzo, Mariel E. Turner, Alejandro J. Torres, Matthew A. Crystal & Amee Shah

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  1. Ashish A. Ankola
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  2. Michael P. DiLorenzo
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  3. Mariel E. Turner
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  4. Alejandro J. Torres
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Correspondence to Ashish A. Ankola.

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Ankola, A.A., DiLorenzo, M.P., Turner, M.E. et al. Left Ventricular Strain Normalizes After Balloon Aortic Valvuloplasty in Infants with Congenital Aortic Stenosis. Pediatr Cardiol 41, 576–583 (2020). https://doi.org/10.1007/s00246-020-02322-1

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