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[Congenital aortic valve stenosis. Long-term results after valvulotomy]
Insights
Aortic valvulotomy for congenital aortic stenosis offers good survival rates, but remains palliative. Patients may still face sudden death, highlighting the need for ongoing monitoring and potential reoperation.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Context:
- Review of 73 patients undergoing valvulotomy for congenital valvular aortic stenosis (1957-1982).
- Exclusion of infants under 12 months old.
- Data updated via outpatient recall and physician questionnaires.
Purpose:
- To evaluate the long-term outcomes and survival rates of aortic valvulotomy in pediatric patients.
- To assess the efficacy and limitations of valvulotomy as a palliative procedure.
Summary:
- Operative mortality was 5.4% (5 deaths). Follow-up ranged up to 25 years.
- 6 patients required reoperation with no mortality; 4 non-reoperated patients developed significant aortic regurgitation.
- Actuarial survival at 5 and 10 years was 92.82% and 86.83%, respectively.
Impact:
- Aortic valvulotomy is a palliative procedure for congenital aortic stenosis.
- Long-term survival is achievable, but the risk of sudden death persists.
- Highlights the need for lifelong patient surveillance and consideration of future interventions.
Abstract:
The cases of 73 patients undergoing valvulotomy for congenital valvular aortic stenosis between 1957 and 1982 were reviewed. Data was updated after recalling patients to the outpatient clinic and/or analysis of the results of a questionnaire sent to the patient's family doctor or cardiologist. Babies less than 12 months old at the time of surgery were excluded from the study. Operation consisted of valvulotomy under direct control with few associated procedures as the valvular lesion was isolated in 89 p. 100 of cases. 5 patients died in the first 30 postoperative days, an operative mortality of 5,4 p. 100. The follow-up period ranged from 1 to 25 years, with 15 patients having been followed up for over 10 years. 6 patients were reoperated with no operative mortality. 2 of whom have since undergone a second reoperation. Of the 59 patients not re-operated, 54 were class I and 5 class II of the NYHA. Of the latter group, 4 are candidates for aortic valve replacement for significant aortic regurgitation. The actuarial survival graph shows a 92.82 p. 100 probability of survival at 5 years, and 86.83 p. 100 at 10 years. Aortic valvulotomy remains a palliative operation which does not protect the patient from subsequent sudden death.