Progressive Congenital Valvar Aortic Stenosis During Infancy: Five Cases

Anand, R.; Mehta, Ashok V.

doi:10.1007/s002469900105

Cited by 9 publications

(8 citation statements)

References 7 publications

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“…This usually takes weeks after delivery to occur. 578 Infants with a mild valve abnormality and normal cardiac function are unlikely to display any symptoms in the neonatal period, although progression of valve dysfunction may occur relatively rapidly 486,[579][580][581][582] and close follow-up is prudent. For these minimal-risk newborns, no specialized care is recommended in the delivery room.…”

Section: Chd With Minimal Risk During Transitionmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,020

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Chd With Minimal Risk During Transitionmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,020

543

View full text Add to dashboard Cite

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“…Bicuspid or unicommissural aortic valves are responsible for 80–95% of cases of aortic valve disease detected in early life 2930 Aortic stenosis in infancy may be rapidly progressive31 but deterioration over a period of years is more usual. In a study of 239 patients born with aortic stenosis32 (excluding “mild stenosis” and presumably also normally functioning bicuspid aortic valves), 95% of those with an initial gradient of 41–80 mm Hg and 30% with a lesser gradient became symptomatic after a mean of 9.2 years.…”

Section: Specific Complicationsmentioning

confidence: 99%

Clinical significance of the bicuspid aortic valve

Ward

2000

Heart

720

513

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“…In contrast, trileaflet valves have better long‐term outcome after surgery . Varying degrees of valvular thickening and decreased mobility can be seen with stenotic aortic valves . In bicuspid aortic valves, the right noncoronary cusp fusion is associated with a more rapid progression of AS and AR and a shorter time to valve intervention .…”

Section: Resultsmentioning

confidence: 99%

“…The lack of standardization in the echocardiographic assessment of aortic and pulmonary valve disease in children may produce heterogeneities in the assessment of disease severity. For example, varied thresholds for transvalvular gradient have been used to define mild, moderate, or severe obstruction in aortic and pulmonary stenosis . The aim of this article was to review the literature on pediatric semilunar valvular heart disease, focusing specifically on the heterogeneity and limitations of current echocardiographic classification systems.…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic assessment of pediatric semilunar valve disease

et al. 2017

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We reviewed echocardiography literature for the assessment and management of semilunar valve disease in children. A search was performed within the National Library of Medicine using the keywords aortic stenosis (AS), aortic regurgitation, pulmonary stenosis (PS), and pulmonary regurgitation in children. The search was further refined adding the keywords-pediatric, neonates, echocardiographic definition, classification, evaluation. Thirty-eight studies were included. For stenotic lesions, there were sufficient consistencies between Doppler and invasive gradients (especially for PS), while other quantitative parameters used in adults showed significant limitations when applied to children. Heterogeneities remain in the range of Doppler measurements utilized to define mild vs moderate vs severe AS/PS, and to guide management. There is sufficient consensus regarding indications for interventions. In regurgitant lesions, there is weak evidence supporting the use of quantitative or semiquantitative parameters after correction for body surface area; clear indications for intervention are lacking. Because adult echocardiographic recommendations cannot be simply translated to the pediatric age, more specific pediatric guidelines and standards for the assessment of semilunar valve disease are needed.

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Progressive Congenital Valvar Aortic Stenosis During Infancy: Five Cases

Cited by 9 publications

References 7 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Clinical significance of the bicuspid aortic valve

Echocardiographic assessment of pediatric semilunar valve disease

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