| Influence of atrial septal defect on mitral valve growth after repair of coarctation of the aorta or an interrupted aortic arch in infants |
Yi-Chia Wang1 
, Hen-Wen Chou2
, Chi-Hsiang Huang1
, Hsing-Hao Huang1
, Yih-Sharng Chen2
, En-Ting Wu3
, Shyh-Jye Chen4
, Ming-Tai Lin3
, Shuenn-Nan Chiu3
, Shu-Chien Huang2
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1Department of Anesthesiology, National Taiwan University Hospital, Taiwan
2Department of Surgery, National Taiwan University Hospital, Taiwan
3Department of Pediatrics, National Taiwan University Hospital, Taiwan
4Department of Radiology, National Taiwan University Hospital, Taiwan |
Correspondence:
Shu-Chien Huang, Email: cvshuang@gmail.com
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Received: 8 September 2025 • Revised: 11 November 2025 • Accepted: 21 November 2025 |
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| Abstract |
Background
Patients with coarctation of the aorta (CoA) and an interrupted aortic arch (IAA) may present with small mitral valves (MVs) and a reduced left ventricular (LV) volume. Biventricular repair (BVR) in these patients is dependent on adequate size of the left cardiac structures.
Purpose
This study evaluated the impact of the hemodynamic characteristics of atrial septal defects (ASDs) on MV growth following surgical repair.
Methods
We retrospectively reviewed the data of patients diagnosed with CoA or IAA between 2007 and 2024. The z score for MV size measured 6 months postoperatively (Z2) was compared with the preoperative MV size (Z1). The factors associated with MV growth were also studied.
Results
A total of 161 patients with CoA or IAA were included. Transthoracic echocardiography was used to assess the MV and LV dimensions preoperatively and 6 months postoperatively. Of the cohort, 155 (96.3%) underwent initial BVR and 6 underwent single-ventricle palliation. MV z scores significantly increased following BVR (mean change: +0.45±1.35; P<0.001) but decreased after single-ventricle repair (-0.56±0.49, P=0.04). Multivariate analysis identified the initial MV z score and ASD pressure gradient as independent predictors of MV growth (R²=0.39).
Conclusion
Annular growth of the MV was not observed in patients who underwent single-ventricle palliation. In contrast, among patients who achieved BVR, those with a small preoperative MV annulus and low ASD pressure gradient demonstrated subsequent catch-up MV growth, suggesting that adequate left-sided preload isessential for MV development. |
| Key Words:
Hypoplastic Left Heart Syndrome, Aortic Arch, Interrupted, Mitral valve, Atrial heart septal defects, Aortic coarctation |
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