Cardiac Imaging Predictors of Ventricular Recovery in Pediatric Patients Undergoing Aortic Valve Intervention for Regurgitation

The optimal timing of aortic valve intervention in children and young adults with chronic aortic regurgitation (AR) remains poorly defined. Surgical thresholds derived from adult populations may not reliably predict left ventricular (LV) reverse remodeling or functional recovery in younger patients, whose myocardium and adaptive responses differ substantially. The objective of this study was to identify preoperative echocardiogram and cardiac magnetic resonance (CMR) parameters associated with postoperative LV recovery in young patients with AR. We conducted a retrospective study of patients younger than 30 years with moderate-to-severe AR who underwent aortic valve surgery. LV recovery was defined as normalization of LV volumes and systolic function within 6–12 months following surgery. Preoperative imaging variables were compared between patients with and without LV recovery. Logistic regression analysis was used to identify predictors of postoperative LV recovery. Twenty-two patients (mean age 16 years) were included. Postoperative improvement in LV dimensions was observed in 91% of patients. Complete LV recovery occurred in only 77%. Larger echocardiographic LV end-systolic volume (LVESV) was associated with reduced odds of LV recovery. Impaired CMR derived global circumferential strain (GCS) was significantly associated with failure to achieve LV recovery. In our cohort with chronic AR, preoperative echocardiographic LVESV and CMR-derived GCS were associated with postoperative LV recovery, whereas adult-derived volumetric thresholds were less predictive. This underscores the limitations of applying adult surgical criteria to younger patients and suggests advanced imaging markers may better inform optimal timing of intervention. Larger prospective studies are needed to validate these findings.