Congenital valvular aortic stenosis: surgical management and long-term results.

Case histories of 50 consecutive infants and children ith congenital valvular aortic stenosis treated at The Montreal Children's Hospital during the past 16 years were reviewed in order to determine the efficacy of the initial treatment as well as the long-term results. The operative technique employed was to incise fused commissures out almost to the anulus without causing aortic insufficiency, but often the accomplishment was limited by valve anatomy or cusp dysplasia. Six of the seven operative deaths occurred in infants. Eight to 16 year follow-up on the first 25 survivors revealed one late death, four "good" results, five aortic valve replacements, and three second valvotomies. Ten patients have recurrent aortic stenosis and two have moderate aortic insufficiency. Aortic valvotomy is a palliative operation, and about a third of the children operated upon will require a second operation within 10 years.