Cardiac Imaging Predictors of Ventricular Recovery in Pediatric Patients Undergoing Aortic Valve Intervention for Regurgitation
Recommended Citation
Flerlage E, Gandhi R, Ndiaye C, et al. Cardiac Imaging Predictors of Ventricular Recovery in Pediatric Patients Undergoing Aortic Valve Intervention for Regurgitation. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
The management of children with aortic regurgitation (AR) remains controversial. Adult surgical criteria are frequently applied to pediatric patients, yet normalization of left ventricular (LV) size and function postoperatively is not always achieved. We sought to identify preoperative imaging parameters that predict postoperative LV recovery in pediatric and young adult patients undergoing aortic valve intervention for chronic AR.
Purpose:
Defining imaging markers that distinguish reversible from irreversible remodeling is critical to prevent lifelong cardiac dysfunction.
Methods:
We retrospectively studied patients <30 years from 2020-2024 with at least moderate AR who underwent aortic valve surgery and had preoperative and >6–12-month postoperative imaging. We divided the cohort into two groups based on if LV recovery was achieved, which was defined as meeting ≥3 criteria of normalization of LV size and function on postoperative imaging. Preoperative imaging variables were compared between recovery and non-recovery groups. Logistic regression identified predictors of LV recovery.
Results:
Overall, 22 patients (mean age 16 years) were included; 91% demonstrated improvement in LV size postoperatively, but only 77% achieved LV recovery. On preoperative echocardiograms, smaller systolic volumes (LVESV 61.0 mL vs 132.8 mL, p=0.017) and better systolic function were associated with LV recovery. This trend was similar via cardiac MRI, but not statistically significant given a small sample size. Impaired preoperative strain parameters by MRI were significantly associated with failure of LV recovery. When compared to adult volumetric thresholds associated with increased mortality (LVESVi ≥45 mL/m2), 86% of patients with normal function still achieved LV recovery.
Conclusion:
Most of our cohort achieved LV recovery despite large ventricular volumes. Systolic LV volumes and function parameters such as MRI derived strain provide prognostic value and may better guide surgical timing. Adult-based volumetric criteria alone did not reliably predict who achieved LV recovery and suggest different reverse remodeling capabilities of pediatric patients. This highlights the need for pediatric-based surgical guidelines to prevent irreversible myocardial injury. We are currently developing a larger, multi-center project to further investigate.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Document Type
Poster
Open Access
Available to all.
Cardiac Imaging Predictors of Ventricular Recovery in Pediatric Patients Undergoing Aortic Valve Intervention for Regurgitation
Background/Significance:
The management of children with aortic regurgitation (AR) remains controversial. Adult surgical criteria are frequently applied to pediatric patients, yet normalization of left ventricular (LV) size and function postoperatively is not always achieved. We sought to identify preoperative imaging parameters that predict postoperative LV recovery in pediatric and young adult patients undergoing aortic valve intervention for chronic AR.
Purpose:
Defining imaging markers that distinguish reversible from irreversible remodeling is critical to prevent lifelong cardiac dysfunction.
Methods:
We retrospectively studied patients <30 years from 2020-2024 with at least moderate AR who underwent aortic valve surgery and had preoperative and>6–12-month postoperative imaging. We divided the cohort into two groups based on if LV recovery was achieved, which was defined as meeting ≥3 criteria of normalization of LV size and function on postoperative imaging. Preoperative imaging variables were compared between recovery and non-recovery groups. Logistic regression identified predictors of LV recovery.
Results:
Overall, 22 patients (mean age 16 years) were included; 91% demonstrated improvement in LV size postoperatively, but only 77% achieved LV recovery. On preoperative echocardiograms, smaller systolic volumes (LVESV 61.0 mL vs 132.8 mL, p=0.017) and better systolic function were associated with LV recovery. This trend was similar via cardiac MRI, but not statistically significant given a small sample size. Impaired preoperative strain parameters by MRI were significantly associated with failure of LV recovery. When compared to adult volumetric thresholds associated with increased mortality (LVESVi ≥45 mL/m2), 86% of patients with normal function still achieved LV recovery.
Conclusion:
Most of our cohort achieved LV recovery despite large ventricular volumes. Systolic LV volumes and function parameters such as MRI derived strain provide prognostic value and may better guide surgical timing. Adult-based volumetric criteria alone did not reliably predict who achieved LV recovery and suggest different reverse remodeling capabilities of pediatric patients. This highlights the need for pediatric-based surgical guidelines to prevent irreversible myocardial injury. We are currently developing a larger, multi-center project to further investigate.
Affiliations
Advocate Children's Hospital, Advocate Christ Medical Center, Advocate Lutheran General Hospital