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HERDIN Record #: PCHRD070908030712 Submitted: 07 July 2008

Long-term outcome of aortic valve disease in rheumatic heart disease patients after a mitral valve intervention .

Lavernie A. Jacobo,
Kurt Glenn C. Jacoba,
Judy Theresa P. Fortinez

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Background This study was performed to assess the long-term outcome of untreated mild to moderate aortic valve (AV) disease present at the time mitral valve (MV) intervention and to identify factors that can predict progression of aortic valve lesions.

Methods and Results - A total of 88 subjects, 19 years old and above, who underwent mitral valve intervention with concomitant mild to moderate aortic valve disease were studied. Subjects were classified into 3 groups: 1) those subjects with isolated aortic stenosis (AS); 2) those subjects with pure aortic regurgitation (AR); 3) those with combined AS and AR at the time of MV intervention. From these subjects, progression of AV disease was followed-up. Follow-up data were obtained using the 2DED study results. The primary endpoint was the year when the progression of AV disease was noted. Subjects classified into those with combined AS and AR at the time of MV intervention accounted for 20 of the 88 study subjects. The remaining 68 subjects (n=88) were identified to have had pure AR None of the 88 subjects were classified under isolated aortic stenosis. It was observed that only 24 percent (16 out of 68 subjects) with pure AR had progression of the AR and freedom from development of moderate to severe AV disease in patients who initially had pure mild-moderate AR was 90 percent in 2 years, 83 percent in 5 years and 66 percent in 8 years. On the other hand, it was noted that about 50 percent (10 out of 20 subjects) with initial AS and AR had progression to moderate to severe AV lesions, and freedom from development of moderate to severe AV disease was 60 percent in 2 years, 40 percent in 5 years, and 25 percent in 8 years time. It was significantly less (p<0.0001) than those who had pure AR lesions initially. Among the demographic factors analyzed, only the presence of mild AS with AR at the initial intervention predicted for development of significant AV disease on follow-up.

Conclusion ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Mild to moderate pure aortic regurgitation usually progresses more slowly and rarely develop into a hemodynamically significant AV disease over a long follow-up period. However, a combined AS and AR lesion progresses more rapidly and needs a closer follow-up. Of the various factors analyzed, the presence of mild AS with AR at initial presentation is significantly correlated with increased rate of AV disease progression. (Author)

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Quarterly
Publication Date
April-June 2006
Volume
12
Issue
2
Page(s)
9-13

Objectives

General Objectives:
1. To assess the long-term outcome of untreated aortic valve disease present at the time mitral valve intervention.
2. To identify factors that can predict progression of aortic valve lesions.

Specific Objectives:
1. To identify the demographic and clinical characteristics of the patients such as gender, age, body-mass index, presence of concomitant tricuspid valve lesion, and history of recurrent congestive heart failure, infective endocarditis or rheumatic fever reactivation.
2. To identify the echocardiographic characteristics that may be associated with the progression of the untreated mild to moderate aortic valve disease which includes calcification of the annulus or valve, retraction of valve cusps, mean aortic valve gradient and left ventricular ejection fraction.
3. To identify the kind of mitral valve intervention or surgery done that may be correlated to the deterioration of mild to moderate aortic valve disease.

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)