Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1982 Jan;47(1):26–34. doi: 10.1136/hrt.47.1.26

Open aortic valvotomy for congenital aortic stenosis. Late results.

P Presbitero, J Somerville, R Revel-Chion, D Ross
PMCID: PMC481091  PMID: 7055509

Abstract

Forty-nine consecutive patients, aged 2 to 28 years, were followed after open aortic valvotomy. Three late deaths occurred in relation to reoperation. Seventeen reoperations were performed 2 to 14 years after valvotomy for severe stenosis in 12 patients, aortic regurgitation in three patients, and aortic stenosis and regurgitation in two patients. Among the 12 patients who required reoperation for severe obstruction, five aged over 19 years had calcified valves with normal aortic roots and valve replacement was simple. Seven had tunnel obstruction with a hypoplastic aortic root, constituting a difficult surgical problem, and necessitating total aortic root replacement in four. The postoperative course after simple aortic valvotomy is determined by several factors; the basic pathological form of the obstruction is the most important. Those who present in the first decade with lumpy valves and small aortic roots tend to form a diffuse tunnel obstruction when residual stenosis remains after valvotomy; older patients with pliable domed valves slowly develop calcified cusps and present less problems as the aortic root is usually a good size. Although aortic valvotomy offers good early results with a low mortality, it should be regarded as palliative as all patients will ultimately require reoperation. Younger patients with lumpy valves and a small aortic root have more problems and may require different initial management.

Full text

PDF
29

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bernhard W. F., Keane J. F., Fellows K. E., Litwin S. B., Gross R. E. Progress and problems in the surgical management of congenital aortic stenosis. J Thorac Cardiovasc Surg. 1973 Sep;66(3):404–419. [PubMed] [Google Scholar]
  2. COOLEY D. A., BEALL A. C., Jr, HALLMAN G. L., BRICKER D. L. OBSTRUCTIVE LESIONS OF THE LEFT VENTRICULAR OUTFLOW TRACT; SURGICAL TREATMENT. Circulation. 1965 Apr;31:612–621. doi: 10.1161/01.cir.31.4.612. [DOI] [PubMed] [Google Scholar]
  3. Chiariello L., Agosti J., Vlad P., Subramanian S. Congenital aortic stenosis. Experience with 43 patients. J Thorac Cardiovasc Surg. 1976 Aug;72(2):182–193. [PubMed] [Google Scholar]
  4. Conkle D. M., Jones M., Morrow A. G. Treatment of congenital aortic stenosis. An evaluation of the late results of aortic valvotomy. Arch Surg. 1973 Nov;107(5):649–651. doi: 10.1001/archsurg.1973.01350230009003. [DOI] [PubMed] [Google Scholar]
  5. ELLIS F. H., Jr, ONGLEY P. A., KIRKLIN J. W. Results of surgical treatment for congenital aortic stenosis. Circulation. 1962 Jan;25:29–38. doi: 10.1161/01.cir.25.1.29. [DOI] [PubMed] [Google Scholar]
  6. Fisher R. D., Mason D. T., Morrow A. G. Results of operative treatment in congenital aortic stenosis. Pre- and postoperative hemodynamic evaluations. J Thorac Cardiovasc Surg. 1970 Feb;59(2):218–224. [PubMed] [Google Scholar]
  7. Hossack K. F., Neutze J. M., Lowe J. B., Barratt-Boyes B. G. Congenital valvar aortic stenosis. Natural history and assessment for operation. Br Heart J. 1980 May;43(5):561–573. doi: 10.1136/hrt.43.5.561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Jack W. D., 2nd, Kelly D. T. Long-term follow-up of valvulotomy for congenital aortic stenosis. Am J Cardiol. 1976 Aug;38(2):231–234. doi: 10.1016/0002-9149(76)90155-7. [DOI] [PubMed] [Google Scholar]
  9. Lawson R. M., Bonchek L. I., Menashe V., Starr A. Late results of surgery for left ventricular outflow tract obstruction in children. J Thorac Cardiovasc Surg. 1976 Mar;71(3):334–341. [PubMed] [Google Scholar]
  10. SPENCER F. C., NEILL C. A., BAHNSON H. T. The treatment of congenital aortic stenosis with valvotomy during cardiopulmonary bypass. Surgery. 1958 Jul;44(1):109–124. [PubMed] [Google Scholar]
  11. Shackleton J., Edwards F. R., Bickford B. J., Jones R. S. Long-term follow-up of congenital aortic stenosis after surgery. Br Heart J. 1972 Jan;34(1):47–51. doi: 10.1136/hrt.34.1.47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Somerville J., Ross D. Congenital aortic stenosis--an unusual form. Consideration of surgical management. Br Heart J. 1971 Jul;33(4):552–558. doi: 10.1136/hrt.33.4.552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Somerville J., Stone S., Ross D. Fate of patients with fixed subaortic stenosis after surgical removal. Br Heart J. 1980 Jun;43(6):629–647. doi: 10.1136/hrt.43.6.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Stewart J. R., Paton B. C., Blount S. G., Jr, Swan H. Congenital aortic stenosis: ten to 22 years after valvulotomy. Arch Surg. 1978 Nov;113(11):1248–1252. doi: 10.1001/archsurg.1978.01370230038004. [DOI] [PubMed] [Google Scholar]
  15. Thomson N. B., Jr, Fisher F. C. Long-term postoperative follow-up in surgery for congenital aortic valvular stenosis. Circulation. 1965 Nov;32(5):732–739. doi: 10.1161/01.cir.32.5.732. [DOI] [PubMed] [Google Scholar]
  16. Thomson R., Yacoub M., Ahmed M., Somerville W., Towers M. The use of "fresh" unstented homograft valves for replacement of the aortic valve. Analysis of 8 years' experience. J Thorac Cardiovasc Surg. 1980 Jun;79(6):896–903. [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES