Successful aortic valvotomy for severe congenital valvular aortic stenosis in the newborn infant

The preoperative evaluation, surgical course, and early follow-up results of 11 newborn infants less than 30 days of age who underwent aortic valvotomy for severe valvular aortic stenosis between 1976 and 1983 were reviewed to determine our current surgical mortality and the early prognosis of these neonates. Ten of the 11 patients had severe congestive heart failure and dyspnea. Preoperative cardiac catheterization and angiography detected features characteristic of congenital aortic valvular stenosis in newborn infants. Emergency aortic valvotomy was performed in all during cardiopulmonary bypass, for which a cold (4 degrees C) blood prime and moderate systemic hypothermia were used. An effort was made to achieve maximal relief of the stenosis without causing aortic insufficiency. Mean cardiopulmonary bypass time was 21 minutes and mean cross-clamp time was 6.4 minutes. There was a single operative death, and there have been no late deaths during a mean follow-up period of 2.2 years. All patients are currently free of heart failure. Four patients underwent postoperative cardiac catheterization for clinical suspicion of severe residual stenosis. However, three had only mild or moderate residual stenosis. The fourth had a large gradient, 70 mm Hg, and has since undergone successful repeat valvotomy. These results indicate that neonates with severe valvular aortic stenosis can undergo valvotomy safely and have a favorable early prognosis. The factors responsible for the low mortality appear to include prompt recognition and diagnosis followed by emergency operation, use of a 4 degree C cold pump prime, brief cross-clamp times, and conservative valvotomy to avoid the development of significant aortic insufficiency.