Open valvotomy for critical aortic stenosis in infancy.

Area of Science:

• Pediatric Cardiology
• Cardiac Surgery
• Congenital Heart Disease

Background:

• Critical aortic stenosis is a severe congenital heart defect requiring early intervention.
• Infants with critical aortic stenosis face significant risks and potential long-term complications.

Purpose of the Study:

• To evaluate the outcomes of open valvotomy in infants with critical aortic stenosis.
• To assess the long-term cardiac function and need for re-intervention in this patient group.

Main Methods:

• A retrospective review of 13 infants under one year old who underwent open valvotomy for critical aortic stenosis over a 5-year period.
• Post-operative follow-up included echocardiographic assessment of left ventricular function and aortic valve gradients.
• Analysis of late mortality and need for subsequent interventions.

Main Results:

• All 13 infants survived the initial open valvotomy procedure.
• Two late deaths occurred, one unrelated to the primary procedure and another after aortic root enlargement and valve replacement.
• Follow-up revealed significantly impaired left ventricular systolic function in all age groups and abnormal diastolic thinning in older children.
• Aortic valve gradients remained elevated in most patients, with one requiring successful percutaneous balloon dilatation for restenosis.

Conclusions:

• Open valvotomy is a viable initial treatment for critical aortic stenosis in infants, offering immediate survival.
• Long-term left ventricular dysfunction persists despite successful surgery, highlighting the need for ongoing monitoring.
• Further interventions may be necessary to manage restenosis and improve long-term outcomes.