IS IT POSSIBLE TO PREDICT THE SEVERITY OF AORTIC REGURGITATION IN A POST‐VALVULOPLASTY PROCEDURE THROUGH KNOWLEDGE OF AORTIC ANATOMY BY ECHO?

Objectives: To determinate if it is possible to predict the severity of aortic regurgitation before balloon aortic valvuloplasty through knowledge of aortic anatomy by echo. Background: Twenty patients with severe aortic stenosis were evaluated by echocardiography (echo), before and after the balloon aortic valvuloplasty (BAV) procedure. Two clearly distinct types of bicuspid aorta were found: with vertical and horizontal closing. Those with the vertical closing had a significantly greater severity of aortic regurgitation than those with horizontal closings. Methodology: Before and after the BAV procedure there were recordings in 20 patients with severe aortic stenosis. At the time of the valvuloplasty procedure (BAV), the patients ranged in age from 3 days to 19 years (mean 3.3 years ± 5). Transthoracic parasternal long- and short-axis views at the level of the aortic valve were used to determine cusp fusion site, and aortic regurgitation was graded using pulsed or colored Doppler or both. Criteria of regurgitation were: light (detectable jet adjacent to the valve or narrow jet of low amplitude detected near the aortic valve), moderate (easily detected, moderate amplitude jet associated with left ventricular dilatation), and severe (wide and easily detected high amplitude jet with marked left ventricular enlargement). We found two clearly distinct types of bicuspid aorta: those that had fusion of the right and noncoronary cusp (showed vertical closings in previous echo), and those with fusion of left and right coronary cusps (showed horizontal closings). Statistical Analysis: Statistical significance p < 0.05. Results: Of twenty patients with severe aortic stenosis, with an average age of 4.5 ± 5 (range: 3–19 years) at the time of BAV was effective in 18, with a mean gradient of 87 ± 12 pre-BAV / 30 ± 11 post-BAV. Of the 20 patients with aortic BAV, 15 had horizontal closings in the previous echo, and 5 had vertical closings. Of the 15 with horizontal closings, 14 had light regurgitation. Only one patient had early moderate regurgitation and two more had moderate regurgitation later on, at 4.5 and 16 years. No patient, except the patient with early moderate regurgitation, had severe regurgitation; only in one patient BAV was not effective. While there were 5 patients with vertical closing, 4 with effective BAV had early moderate-to-severe regurgitation in immediate post-procedure, 1/5 was no effective. Conclusion: A light post-procedure insufficiency may be expected in a bicuspid aorta with horizontal closing post aortic valvuloplasty (14/15). We also expected an efficient procedure in the reduction of the aortic stenosis (14/15). A significative aortic regurgitation may be expected in a bicuspid aorta with vertical closing post BAV (4/4).