Current treatments for congenital aortic stenosis

Area of Science:

• Cardiology
• Pediatric Surgery
• Congenital Heart Disease

Background:

• Congenital valvar aortic stenosis presents a spectrum of severity, from mild to critical forms like hypoplastic left heart syndrome.
• Management often necessitates repeated palliative interventions, highlighting the need for effective treatment strategies.

Purpose of the Study:

• To review outcomes and optimal timing of interventions for congenital valvar aortic stenosis.
• To assess recent advances including fetal balloon valvuloplasty, the Ross procedure, and trans-catheter balloon valvuloplasty.

Main Methods:

• Review of current literature and long-term studies on various interventions for congenital valvar aortic stenosis.
• Analysis of outcomes related to fetal, neonatal, infant, and pediatric patient populations.

Main Results:

• Fetal balloon valvuloplasty demonstrates potential for promoting fetal left ventricular growth, enabling biventricular repair in select cases.
• Trans-catheter balloon valvuloplasty offers excellent initial results in neonates and infants, though surgical intervention may be required for resistant stenosis or regurgitation.
• The Ross procedure shows encouraging midterm outcomes, but long-term monitoring for pulmonary allograft stenosis and aortic insufficiency is crucial.

Conclusions:

• Fetal balloon valvuloplasty holds promise for improving fetal cardiac development, despite limited availability.
• Trans-catheter balloon valvuloplasty is the preferred intervention for infants and neonates with aortic stenosis.
• The Ross procedure is the current repair of choice for older patients, with ongoing research into autograft durability and allograft advancements.