Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
Catheter Cardiovasc Interv. 2013 Jan 1;81(1):90-5. doi: 10.1002/ccd.24286. Epub 2012 Oct 8.
Evaluate the incidence of various morphologic types of congenital AS, and the association between valve morphology and long-term outcomes, including repeat BAV, AVR, and death/transplant.
Reports on long-term outcomes have low agreement on the influence of morphologic type.
We queried our institutional database and hospital billing records to identify all patients who underwent balloon aortic valvuloplasty (BAV) from 1992 through 2009. We excluded cases where morphology was not clear based on the description in the pre-BAV echocardiogram report and patients who underwent single ventricle palliation. The primary outcome of the study was the occurrence of any of the following events: repeat valvuloplasty, AVR, heart transplant, or death.
There were 147 patients in our study cohort. The most common morphology was functionally bicuspid (n = 92, 63%), followed by functionally unicuspid (n = 20, 14%), dysplastic (n = 16, 11%), true bicuspid (n = 13, 9%), and true unicuspid (n = 6, 4%). The primary endpoint was less likely to occur in patients with functionally bicuspid valves (P < 0.01) and patients with true bicuspid valves (P = 0.03), whereas it was more likely to occur in patients with functionally unicuspid valves (P = 0.02) and patients with true unicuspid valves (P = 0.05). Multivariate Cox regression analysis demonstrated that valve type other than functionally bicuspid was associated with diminished freedom from repeat intervention, death or transplant (HR 3.3, CI 1.2 - 8.6, P = 0.02).
In our cohort, patients with functionally bicuspid aortic valves, the most common type, had improved outcomes as compared with all other morphologic types.
评估先天性主动脉瓣狭窄（AS）各种形态类型的发生率，以及瓣膜形态与长期结局之间的关系，包括再次球囊主动脉瓣成形术（BAV）、主动脉瓣置换术（AVR）和死亡/移植。
关于形态类型对长期结局影响的报道一致性较低。
我们查询了机构数据库和医院计费记录，以确定 1992 年至 2009 年间接受球囊主动脉瓣成形术（BAV）的所有患者。排除基于 BAV 术前超声心动图报告中的描述形态不明确的病例和接受单心室姑息治疗的患者。本研究的主要结局是发生以下任何事件：再次行瓣膜成形术、AVR、心脏移植或死亡。
我们的研究队列中有 147 例患者。最常见的形态是功能性二叶瓣（n = 92，63%），其次是功能性单叶瓣（n = 20，14%）、发育不良（n = 16，11%）、真性二叶瓣（n = 13，9%）和真性单叶瓣（n = 6，4%）。主要终点在功能性二叶瓣患者（P < 0.01）和真性二叶瓣患者（P = 0.03）中发生的可能性较小，而在功能性单叶瓣患者（P = 0.02）和真性单叶瓣患者（P = 0.05）中发生的可能性较大。多变量 Cox 回归分析表明，除功能性二叶瓣以外的瓣膜类型与再次干预、死亡或移植的几率降低有关（HR 3.3，CI 1.2 - 8.6，P = 0.02）。
在我们的队列中，最常见的功能性二叶瓣患者的结局优于所有其他形态类型。
