Aortic valvulotomy in neonates.

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Abstract
Newborns [14], 1 mo. of age or younger (mean age 12 days; mean weight 3.5 kg), had aortic valvulotomy for critical life-threatening aortic stenosis. Seven infants died early and 7 survived hospitalization. Clinical, laboratory, catheterization, operative and autopsy data were analyzed to determine factors relevant to success or failure. Left ventricular chamber size and operability of the aortic valve and annulus were the most important determinants of outcome. All nonsurvivors except 1 had small left ventricles. All survivors had normal-sized ventricles and aortic annuli > 5 mm. Left ventricular end-diastolic folumes (LVEDV) were calculated from cineangiograms in 10 infants. Six survivors and 1 nonsurvivor, who developed ventricular fibrillation before bypsss, had LVEDV > 35 ml/m2. Poor peripheral perfusion, severe acidosis (pH < 7.25) and right ventricular hypertension (> 60 torr) were significantly more common in nonsurvivors than in survivors. Seven nonsurvivors and only 1 survivor either required immediate operation or developed ventricular fibrillation during operation before bypass. Two subgroups of newborns with isolated aortic stenosis are identified. Those with small left ventricular chambers represent an intermediate group between patients with "hypoplastic left-heart syndrome" and normals. Aortic valvulotomy did not save these infants. In contrast, 7 of 8 newborns with normal-sized left ventricles survived valvulotomy and 6 remain alive 1.5-6.5 yr after operation.