Inflow occlusion for semilunar valve stenosis.

Twenty-nine patients have had valvotomy with inflow occlusion since 1975 at our institution: 7 for aortic stenosis and 22 for pulmonary stenosis. All patients with aortic stenosis and 11 with pulmonary stenosis were neonates. Six patients died, 3 with aortic stenosis and 3 with pulmonary stenosis. All of them were less than 2 days old. Two newborns with critical pulmonary stenosis required reoperation with an outflow patch at age 22 and 25 months. To determine morbidity and expense of inflow occlusion versus cardiopulmonary bypass for patients with pulmonary stenosis, we compared the 11 patients who were not infants and who had inflow occlusion (age range, 3.5 to 26.8 years) with 10 patients who were operated on concurrently and who required bypass to correct associated minor intracardiac lesions (age range, 2.6 to 26.4 years). Significant differences (p less than 0.01) were as follows (inflow occlusion versus bypass): operating room time, 2.0 +/- 0.4 versus 3.6 +/- 0.8 hours (mean +/- standard deviation); blood utilized, 0.3 +/- 0.5 versus 1.7 +/- 1.7 units; and total expense, $4,600 +/- 800 versus $7,000 +/- 1,600. Thus, inflow occlusion is safe in patients more than 2 days old, with early and late results similar to bypass, and is an attractive alternative for patients with isolated pulmonary valvular stenosis and for newborns with aortic stenosis.