Medical College of Wisconsin
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Management strategy for very mild aortic valve stenosis. Pediatr Cardiol 2006 Mar-Apr;27(2):259-62

Date

01/18/2006

Pubmed ID

16411151

DOI

10.1007/s00246-005-1134-x

Scopus ID

2-s2.0-33645114926   7 Citations

Abstract

It is unclear how often patients with very mild aortic stenosis (gradients < 25 mmHg) need interval follow-up. The purpose of this study was to define the determinants of disease severity progression and to propose appropriate management strategies. It is known that congenital aortic stenosis is a progressive disease that requires long-term follow-up at consistent intervals. We studied 89 patients with very mild aortic stenosis. Cox proportional hazard modeling was performed to ascertain predictors of morbidity and mortality. Events were defined as valve surgery or death. Of the original 89 patients, 7 died (92% survival); one death was sudden and unexplained and six were noncardiac. Eighteen individuals were lost to follow-up (10 not located and 8 refused participation). Twelve (17%) had valve surgery. The minimum time interval between initial diagnosis of very mild aortic stenosis and surgery was 4.6 years (mean, 14.0). Age at diagnosis, gender, initial gradient, initial gradient/age, and aortic regurgitation were found not to be predictive of outcome. However, the slope of the transaortic gradient [change of gradient/time (years)] was predictive of outcome (hazard ratio of 1.69; confidence interval, 1.4-2.2). At least 17% of these patients progress to require operation. For patients with a gradient slope < 1.1, evaluation every 4 or 5 years is recommended. For patients with a gradient slope > 1.2, evaluation every 1 or 2 years seems prudent.

Author List

Bartz PJ, Driscoll DJ, Keane JF, Gersony WM, Hayes CJ, Brenner JI, O'Fallon WM, Pieroni DR, Wolfe RR, Weidman WH

Author

Peter J. Bartz MD Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aortic Valve Stenosis
Child
Disease Progression
Female
Follow-Up Studies
Humans
Male
Morbidity
Patient Care Management
Proportional Hazards Models
Survival Rate
United States
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a