CONGENITAL AORTIC-STENOSIS - EXPERIENCE WITH 43 PATIENTS

  • 1 January 1976
    • journal article
    • research article
    • Vol. 72  (2) , 182-193
Abstract
Between Sept. 1967 and Jan. 1975, 43 patients underwent intracardiac repair for congenital aortic stenosis at the Buffalo [New York, USA] Children''s Hospital. The patients ranged in age from 2 days to 24 yr, 6 of them being < 1 yr of age. Valvular aortic stenosis was found in 21 cases (4 infants [Group I-A] and 17 older patients [Group I-B]), discrete subaortic membranous diaphragm in 11 (Group II), diffuse subvalvular muscular obstruction in 3 (Group III), supravalvular stenosis in 4 (Group IV) and multiple-level obstruction in 4 (2 infants [Group V-A] and 2 older patients [Group V-B]). Preoperatively, 58% of the patients were symptomatic and 67% had abnormal ECG. Associated congenital cardiac defects were found in 28% of the cases. The over-all hospital mortality rate was 9% (3 patients in Group I-A and 1 in Group V-A), with no deaths occurring in patients older than 3 mo. of age at the time of operation. Two late deaths occurred (Groups I-B and V-B). A complete heart block developed in 1 patient (Group III). The average intraoperative peak systolic left ventricular-aortic gradient decreased in all groups after repair but progressively increased in the late hemodynamic studies obtained in symptomatic patients. Six patients were reoperated upon for recurrent obstruction. Late results were evaluated on the basis of symptoms, ECG findings, valve function and hemodynamic data. They showed excellent or satisfactory results in 59% of the patients in Group I-B, in 45% in Group II, in 66% in Group III and in 25% in Group I-V. Results were fair or poor in Groups I-A, V-A and V-B. In children and adolescents, effective relief of the obstruction and of the symptoms can be obtained with minimal operative risk and minimal morbidity. In symptomatic infants, despite the high operative mortality rate, surgical intervention is indicated because of the poor prognosis.

This publication has 0 references indexed in Scilit: