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[Aortic valve stenosis. Surgical treatment in children]
A Cabrera Duro1, Y López Fernández, P Martínez Corrales
1Hospital Infantil de Cruces, Baracaldo, Bilbao.
Insights
Aortic commissurotomy is a palliative treatment for pediatric aortic stenosis, with no mortality. Restenosis can occur but is correctable, and aortic regurgitation is typically mild, potentially avoiding valve replacement in childhood.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Aortic valve stenosis (AVS) in children requires effective early intervention.
- Aortic commissurotomy offers a less invasive approach compared to valve replacement.
Purpose of the Study:
- To evaluate the medium-term results of aortic commissurotomy in pediatric patients with aortic valve stenosis.
- To assess the efficacy and safety of this procedure as a primary treatment.
Main Methods:
- Twenty-two children underwent aortic commissurotomy under cardiopulmonary bypass.
- Pre- and post-operative cardiac catheterization and Doppler echocardiography were used for assessment.
- A medium-term follow-up of 8.6 years was conducted.
Main Results:
- No mortality was observed. Restenosis occurred in 7 patients before age 7, successfully managed with further intervention.
- The mean pressure gradient decreased significantly post-surgery (92.5 mmHg to 43.5 mmHg).
- Aortic regurgitation was present in 12 patients post-procedure, mostly mild.
Conclusions:
- Aortic commissurotomy is a palliative but effective treatment for pediatric AVS.
- Restenosis is manageable, and significant aortic regurgitation is uncommon.
- This procedure can help avoid valve replacement in childhood.
Objectives:
The results of aortic commissurotomy, as the first step in the treatment of aortic valve stenosis in children, have been estimated after a medium-term follow-up.
Material And Methods:
Twenty-two patients were operated at a mean age of 7.3 +/- 3.6 years of age. Surgery was performed under cardiopulmonary bypass and moderate hypothermia. Twenty patients underwent cardiac catheterization (the systolic gradient pressure was 67.9 +/- 24.7 mmHg and the end diastolic pressure was 17 +/- 7.1 mmHg). We evaluated 10 patients with Doppler flow echocardiography (the valvular area was 0.8 +/- 0.2 cm2/m2). After surgery, we made a follow-up of 8.6 +/- 5.4 years.
Results:
The aortic valve was bicuspid in 13 cases and tricuspid in 9 cases. There was no mortality. Before the age of 7, 7 patients developed restenosis. The mean pressure gradient was 92.5 +/- 16.6 mmHg, so six of them underwent valvuloplasty and the other one was operated with an aortic valvulated homograft. The pressure gradient, which was estimated in 20 patients, was lowered to 43.5 +/- 17.5 mmHg and the aortic area was increased to 2.4 cm2/m2. Six patients had a pressure gradient above 40 mmHg. Six patients had previous aortic regurgitation and this reappeared in 3 patients after valvulotomy. At this time, 12 patients have aortic regurgitation, being mild in 9 patients, mild to moderate in 1 and moderate in 2 patients.
Conclusion:
Valvulotomy is a palliative therapeutic method. We had no mortality. Restenosis appeared in 7 patients, before the age of seven years, and it can be easily corrected. The aortic regurgitation is usually mild. Valve replacement can be avoided in childhood.