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<p>In hypoplastic left heart syndrome (HLHS) and variants, the pulmonary valve functions as the neo-aortic valve after the Norwood procedure. Neo-aortic valve insufficiency (Neo-AI) represents an emerging complication with implications for long-term survival. This study investigated the clinical impact and patterns of Neo-AI development following staged palliation. Neonates undergoing the Norwood procedure (2001–2023) were retrospectively reviewed. Neo-AI was evaluated using serial echocardiograms, with patients classified into two groups: early onset (during the Norwood hospitalization) and late onset (after the Norwood discharge). Neo-aortic root dimensions were measured at four time points during staged palliation, with Z-scores calculated for patient growth. Among 378 patients, significant Neo-AI developed in 30 (7.9%) during median follow-up of 4.3 years. Early onset neo-AI occurred in 13 patients (43.3%) and late onset neo-AI in 17 (56.7%). Cox regression revealed 7.9-fold increased mortality risk in early onset patients (hazard ratios 7.87, <i>p</i> = 0.009), with 5-year survival of 38.5% versus 87.8% in late onset patients. All early onset deaths occurred within the first year. Late onset neo-AI patients demonstrated progressive sinus of Valsalva dilatation (annual progression 0.33 Z-score units). At Fontan completion, late onset neo-AI patients had larger Z-scores than early onset patients [5.14 vs. 2.18, <i>p</i> = 0.006], while surviving early onset patients demonstrated Neo-AI improvement after bidirectional cavopulmonary shunt with subsequent stable root dimensions. Early onset neo-AI associates with acute hemodynamic compromise and higher perioperative mortality. Late onset neo-AI demonstrates progressive root dilatation with superior survival, raising concerns for future valve intervention.</p>

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Neo-Aortic Valve Insufficiency and Root Dilatation During and After the Staged Palliation for Hypoplastic Left Heart Syndrome and Variants

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月14日

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  • Muneaki Matsubara,
  • Iulia Telescu,
  • Thibault Schaeffer,
  • Teresa Lemmen,
  • Christoph Röhlig,
  • Jonas Palm,
  • Paul Philipp Heinisch,
  • Nicole Piber,
  • Alfred Hager,
  • Peter Ewert,
  • Jürgen Hörer,
  • Masamichi Ono

摘要

In hypoplastic left heart syndrome (HLHS) and variants, the pulmonary valve functions as the neo-aortic valve after the Norwood procedure. Neo-aortic valve insufficiency (Neo-AI) represents an emerging complication with implications for long-term survival. This study investigated the clinical impact and patterns of Neo-AI development following staged palliation. Neonates undergoing the Norwood procedure (2001–2023) were retrospectively reviewed. Neo-AI was evaluated using serial echocardiograms, with patients classified into two groups: early onset (during the Norwood hospitalization) and late onset (after the Norwood discharge). Neo-aortic root dimensions were measured at four time points during staged palliation, with Z-scores calculated for patient growth. Among 378 patients, significant Neo-AI developed in 30 (7.9%) during median follow-up of 4.3 years. Early onset neo-AI occurred in 13 patients (43.3%) and late onset neo-AI in 17 (56.7%). Cox regression revealed 7.9-fold increased mortality risk in early onset patients (hazard ratios 7.87, p = 0.009), with 5-year survival of 38.5% versus 87.8% in late onset patients. All early onset deaths occurred within the first year. Late onset neo-AI patients demonstrated progressive sinus of Valsalva dilatation (annual progression 0.33 Z-score units). At Fontan completion, late onset neo-AI patients had larger Z-scores than early onset patients [5.14 vs. 2.18, p = 0.006], while surviving early onset patients demonstrated Neo-AI improvement after bidirectional cavopulmonary shunt with subsequent stable root dimensions. Early onset neo-AI associates with acute hemodynamic compromise and higher perioperative mortality. Late onset neo-AI demonstrates progressive root dilatation with superior survival, raising concerns for future valve intervention.