Prevalence of Congenital Aortic Valve Regurgitation in a Newborn Cohort

Congenital aortic valve regurgitation is seen in approximately 1 in 4,000 live-births globally. This study investigated the prevalence and early impacts of aortic regurgitation in a newborn cohort. Between April 2016 and October 2018, all newborns in the Copenhagen Area were offered systematic transthoracic echocardiography in a prospective, multicenter population-based study. Aortic valve function was categorized as no, trivial (glimpse of regurgitant flow and/or vena contracta < 0.1 cm), or non-trivial aortic regurgitation (vena contracta ≥ 0.1 cm). Newborns with non-trivial regurgitation were matched 1:4 with controls (no regurgitation). Among 25,590 newborns, aortic regurgitation was detected in 329 newborns (52% male, median age 11 days), i.e. a prevalence of 1.3% (95% CI, 1.15%-1.43%), with 260 (79%) classified as trivial and 69 (21%) as non-trivial. Bicuspid aortic valve was more common in newborns with non-trivial regurgitation (13.0%) than controls (1.1%) (p < 0.001). Newborns with non-trivial regurgitation had larger aortic dimensions compared to controls (mean ± SD): aortic valve annulus (7.3 ± 0.7 mm vs. 7.0 ± 0.6 mm), Sinuses of Valsalva (10.3 ± 1.0 mm vs. 9.7 ± 1.0 mm), sino-tubular junction (8.4 ± 0.8 mm vs. 8.0 ± 0.8 mm), and ascending aorta diameter (10.0 ± 0.9 mm vs. 9.4 ± 1.1 mm) (all p < 0.006). Left ventricular dimensions and function did not differ between groups. Congenital aortic regurgitation was present in 1.3% of all newborns. Non-trivial regurgitation (0.3%) was associated with larger aortic dimensions and higher prevalence of bicuspid aortic valve (13%), but no early signs of left ventricular impairment. Follow-up will help identify those at risk of progression, potentially due to valvular and/or aortic pathology, who may benefit from regular surveillance, and those who can be safely discontinued. Trial registration ClinicalTrials.gov NCT02753348 (registered April 27th 2016).