Aortic and mitral regurgitation (AR and MR) expose the left ventricle (LV) to abnormal load, and carry a risk of progressive contractile dysfunction. In childhood, LV mechanics and predictors of postoperative LV dysfunction are poorly defined.
Methods. Retrospective identification of children and young adults (age <23 years) who underwent surgery for severe combined AR&MR (Group I, n=13), isolated severe AR (Group II, n=14) or MR (Group III n=21), and had suitable echocardiograms for analysis before and 4-18 months after surgery. Cardiac size and function were expressed as z-scores normalised to body surface area and age. The stress velocity index (SVI) was expressed as a z-score normalising shortening to afterload.
Results. LV dilatation in Group I was similar to Group II and greater than Group III (p<0.05). Likewise afterload (fibre stress) was elevated and function depressed to a degree similar to Group II. These parameters were normal in Group III (Table; *=p<0.05 vs. normal). After operation LV dysfunction (EF z-score <-2) was more prevalent in Group I than in Groups II and III (85% vs. 36% vs. 57%, p=0.04). The preoperative end-systolic volume z-score independently predicted postoperative LV dysfunction in Group II and III patients (p=0.03, z-score cut-off 4.8 and 2.5 respectively), but not in Group I where moderate LV dysfunction (EF z-score <-3) was related to the preoperative SVI (p=0.04).
Conclusions. LV mechanics in severe combined AR&MR are similar to those of severe AR but the outcome of the LV is worse. Surgery should be considered at the earliest opportunity.