[Aortic valve stenosis. Surgical treatment in children].

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.