Congenital aortic stenosis. A retrospective study on 32 operated patients.

The magnitude of the peak systolic pressure gradient (PSPG) over the aortic valve was often determining factor when deciding for or against operation of the congenital aortic stenosis. The impression that PSPG alone was an inadequate parameter for assessment of the degree of stenosis was supported by the present retrospective analysis of 32 patients operated upon for this anomaly. A gradient of 75 mmHg or more indicates a tight stenosis but a lower value does not exclude a pronounced constriction of the orifice, any more than does absence of symptoms or signs of left ventricular hypertrophy (LVH) on the ECG. It is probably not only the size of the stenotic orifice that determines the prognosis in aortic stenosis but also other factors, e.g. function of the left ventricular myocardium. A hypothesis was put forward by one of us (M. V.) that the location of the valvular ostium, central or peripheral, can be of importance and that turbulence-induced vibrations of the left ventricular wall may depress the myocardium. Differences in the pathoanatomy of the stenotic aortic valves did not explain the poor correlation between e.g. symptoms or LVH and PSPG or the size of the remaining orifice in the present study.