Congenital Aortic Stenosis

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Abstract
An attempted was made to correlate clinical, hemodynamic, and surgical findings in 43 cases of congenital aortic stenosis. A retrospective study was undertaken to determine whether or not routine clinical evaluation (history, physical examination, chest X-ray and ECG) would have provided any consistent clues as to the severity of disease in terms of the measured gradient across the obstructed area or degree of anatomic narrowing observed at surgery. Definite left ventricular enlargement on radiograms of the chest or left ventricular hypertrophy and strain in the ECG was always associated with critical stenosis. The ECG was a much more sensitive indicator of enlargement of the left ventricle than the chest X-ray, yet half the patients with critical stenosis had normal ECGs. All patients with a gradient of more than 45 mm Hg across the obstructed area had either symptoms or clinical evidence of left ventricular hypertrophy, or both. Cardiac catheterization could have been safely deferred in a given patient if he were asymptomatic and had no definite evidence of left ventricular hypertrophy on physical examination, or by X-ray, or LVH with strain on the ECG.