Contemporary management of risk factors in congenital heart disease 211done through patients' records and the national mortality registry. Results were analysed using Cox proportional-hazards models, Kaplan-Meier estimator and for repeated events the Anderson-Gill method, on an intention-to-treat and ontreatment basis. Results: Eighty-eight consecutive patients (median age 32 years, 57 males, 63 TGA) were followed for a median of 8.3 years since randomization. Use of cardiac drugs after trial closeout was similar in both randomization groups (49% β-blocker, 45% ARB/ACE-inhibitor, 30% antiarrhythmic, 22% diuretic). Six patients (n=3 valsartan, n=3 placebo) died, yielding a long-term survival of 90%. Mortality was predominantly a result of heart failure and sudden death, and higher among symptomatic (19%) than asymptomatic patients (2%, P=0.010). Fifty-three (60%) patients experienced events; supraventricular arrhythmia (n=40), ventricular arrhythmia (n=22), worsening heart failure (n=20), tricuspid valve surgery (n=6), and death (n=6). No difference in separate or the composite endpoint was found between the original valsartan and placebo groups, with corresponding eventfree survival rates of 50% and 34% at 8.3 years (P=0.120). Nevertheless, valsartan significantly reduced the risk for events in symptomatic patients (HR 0.37; 95% CI 0.14-0.92) though not in asymptomatic patients (HR 0.84; 95% CI 0.42-1.69, Figure). Repeated event analysis and time-dependent analysis with posttrial ARB/ACE-inhibitor use did not alter results.Conclusions: Upon 8 years of follow-up, valsartan treatment was not associated with improved survival in sRV patients. However, in symptomatic patients treated with valsartan long-term risk for events was significantly reduced. Therefore, early initiation of such treatment is recommended in these patients. | BEDSIDEBenefit of family screening in patients with isolated bicuspid aortic valve in a general hospital

Background Mitral valve abnormalities (MVA) include mitral valve regurgitation (MR), mitral valve prolapse (MVP), Barlow's mitral valve disease, and parachute MV. The prevalence of MVA has yet to be determined in an unselected population of newborns. Objective To determine the prevalence of MVA in unselected newborns and to assess the left ventricular (LV) structure and function in the neonatal heart with MR. Methods Transthoracic echocardiography (TTE) was performed within 28 days after birth in unselected neonates consecutively included in a prospective, multicenter, population-based study (2016–2018 (n=25,751)). TTE's were systematically reviewed for MR, MVP, Barlow's MV disease, and parachute MV. In a subgroup of 400 newborns with MR, the regurgitation was further classified as either traceable MR, mild MR, or moderate/severe MR based on the ratio of the trans-mitral jet in systole over the diastolic filling duration using M-mode in the 4-chamber view of the LV. Results Of 25,751 included newborns, we found a prevalence of MVA of 26.7%. (6,883/ 25,751). The prevalence of MR was 26.2%, MVP was 0.35%, Barlow's disease was 0.13%, and parachute mitral valve was 0.027%. MR was more frequent in females compared to males (50.4 vs 48.2%, p<0.01). Newborns with MR had enlarged left atrial diameter (11.91±2.03 mm vs 11.53±2.02 mm, p<0.01) and LV end-diastolic and end-systolic diameter (LVIDd 19.98±1.88 mm vs 19.87±1.83 mm, p<0.01, LVIDs 13.48±1.47 mm vs 13.31±1.41 mm, p<0.01), thicker LV posterior wall (2.19±0.60 mm vs 2.05±0.52 mm, p<0.01), increased early and atrial mitral inflow velocities (MV E velocity (0.65±0.14 m/sec vs 0.61±0.13 m/sec, p<0.01), MV A velocity (0.60±0.13 m/sec vs 0.57±0.13 m/sec, p<0.01)), but lower fractional shortening (32.54±4.22% vs. 32.96±4.17%, p<0.01) as compared to newborns without MVA. In subgroup analysis MR severity was classified as traceable in 44% (175/400) of cases, mild MR in 52% (209/400) of cases and moderate/severe MR in 4% (16/400) of cases. Comparing traceable MR with moderate/severe MR (19.48±1.88 mm vs 20.96±2.64 mm, p=0.01) and comparing mild MR with moderate/severe MR (19.85±1.92 mm vs 20.96±2.64 mm, p=0.04) showed significant increases in LV end-diastolic diameter. Conclusion Over one fourth of all newborns had a MV abnormality of which mitral regurgitation accounted for the vast majority. The presence of MR was associated with asymmetric LV remodeling and discrete changes in LV function. Subgroup analysis revealed that increment in MR severity was primarily associated with an increase in LV end-diastolic diameter. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Herlev-Gentofte Hospital

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