[Immediate and long-term results of aortic valvulotomy in aortic valve stenosis]

Between April 1962 and December 1982 we performed valvulotomies on 68 patients to correct valvular aortic stenosis (VAoS). Forty-one were men and 27 women whose ages ranged from 20 months to 47 years (mean = 11.9 +/- 6.4 years). In 95% of cases VAoS was congenital. All patients underwent clinical preoperative evaluation with chest roentgenogram and electrocardiogram (ECG). Catheterization was done on 89.7%. Symptoms varied from none to syncope and stress angina. Symptoms bore no relation to the systolic aortic gradient, which oscillated between 31 and 200 mm Hg. There was a significant postoperative improvement in symptoms and less notable improvement in chest X-rays and ECG. Follow-up was from 1 to 22 years (mean = 7.12 +/- 4.43 years). Thirty-nine patients were followed for 5 or more years with serial clinical, radiological and electrocardiographic control. Fifty percent underwent postoperative catheterization. Seventeen patients continued with residual aortic regurgitation (AoR). Fourteen patients were again operated. A new valvulotomy was performed on 2 and valve replacement was done on the rest. Perioperative mortality was 2.9% and long-term survival 88% with 84.6% of the patients asymptomatic or in functional class I of the NYHA. Survival curves were plotted and the literature reviewed. The conclusion was that although this surgery constitutes a low risk, it should be considered palliative in the majority of the cases.