Surgical therapy for congenital aortic valvular stenosis. A 23 year experience

This is a review of 70 consecutive patients (2 to 20 years old) who underwent valvotomy for congenital aortic valvular stenosis from 1958 through 1980. A tricuspid valve was created in 36, a bicuspid valve in 33, and a valve prosthesis was inserted in one, with two operative deaths (2.8%). There were four late deaths, three due to noncardiac causes. Eleven patients required reoperation from 2 to 21 years (mean 11.3 years) after valvotomy, with two deaths. Seven patients underwent valve replacement. One patient died 9 years after a second valvotomy. The overall survival rate including reoperation was 92.6% for 10 years and 86% for 15 years. Of 53 surviving patients free of reoperation, 49 are in New York Heart Association Class I and four are in Class II. One of the patients in Class II is a candidate for reoperation. The other 52 patients are well. Twenty-three have normal stress tests, and only one of 24 studied has a pressure gradient greater than 50 mm Hg. We concluded from this experience that valvotomy effectively and safely relieves left ventricular outflow tract (LVOT) obstruction produced by congenital aortic valvular stenosis. It delays the time when a prosthetic device will be required to relieve LVOT obstruction.