Surgical Treatment of Congenital Aortic Stenosis by Cardiopulmonary Bypass

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Abstract
The diagnosis of congenital aortic stenosis can usually be made clinically, but it was not possible clinically to differentiate between the 4 anatomic types. Left heart catheteri-zation combined with left ventriculography and selective aortography was most valuable in distinguishing the different forms of aortic stenosis as well as estimating the degree of obstruction. Significant aortic stenosis was rather frequently found to be asymptomatic. Thus, these studies are considered essential in determining the need and timing of surgical correction, the presence of associated defects, and in the planning of the surgical attack upon the stenosis. Congenital aortic stenosis, especially in infants in congestive failure, was frequently associated with serious additional anomalies that aggravated the prognosis, particularly if not detected preoperatively and treated where possible. A definite increase in the systolic gradient across the aortic valve was noted with age and growth in the unoperated patient. A systolic gradient exceeding 40 to 50 mm Hg at rest was considered an indication for surgical correction, especially in children. The preoperative maximum systolic gradient across the obstruction varied between 45 mm Hg and 230 mm Hg, with an average of 95 mm Hg. Postoperatively the maximum systolic gradient varied from 0 to 45 mm Hg, with an average of 18 mm Hg. The systolic thrill disappeared in 74% and the systolic murmur was abolished or decreased to a substantial degree.

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