Aortoventriculoplasty in infants and children

When aortic valve replacement is required in infants or small children with complex left ventricular outflow tract obstruction (LVOTO) or aortic incompetence (AI), the diameter of the annulus may limit the size of the prosthesis that can be safely inserted, and aortoventriculoplasty (AVP) may be required. To assess the results of this procedure in the pediatric age group, we reviewed our results in 19 patients who underwent AVP from May 1986 to April 1991.

Patient age ranged from 1 day to 18 years (mean, 5.9 years), with six patients < 2 years of age and 13 patients younger than 5 years. Operative indications included complex LVOTO after aortic valvotomy and/or subaortic resection (six), severe AI after valvotomy or aortic valve replacement (four), severe AI with bacterial endocarditis (one), truncus arteriosus with truncal insufficiency (three), failure of an apical-aortic conduit (three), and combined aortic stenosis and mitral stenosis (two). In all patients, valve insertion was performed after patch enlargement of the annulus and septum. Associated procedures included coronary artery reimplantation in five patients and mitral valve replacement in two. Mechanical valve prostheses were used in 15 patients and allografts in four. There were three hospital deaths (16%; 70% confidence limit, 9-26%), two in patients with severe pulmonary vascular disease, and no late deaths. Actuarial survival was 84 +/- 8% at 1 month and beyond (mean follow-up, 2.5 years). Complications have included complete heart block (one), residual ventricular septal defect (one), and early postoperative peripheral embolus (one). No late thromboembolic events have occurred. No patient has clinical or echocardiographic evidence of significant residual LVOTO or AI.

These data indicate that AVP may be performed at low risk and that it is an effective procedure for complex LVOTO or AI in infants and small children.