[Immediate and mid-term results of surgery of aortic valve stenosis in the newborn infant].
Between January 1980 and June 1990, 47 consecutive neonates with severe aortic stenosis underwent surgical aortic commissurotomy at Marie-Lannelongue Hospital. The average age at operation was 5 days. Other cardiac abnormalities were present in 27 children and left ventricular fibroelastosis in 11 children. Closed heart aortic valvotomy via the apex of the left ventricle was performed in 26 patients and open heart commissurotomy in 21 patients. Immediate per- or postoperative death was observed in 14 cases (29.8%). Six patients died after open heart valvulotomy (29%) and 8 after closed heart valvulotomy (31%). The mortality was higher in children with a critical preoperative status: 60% versus 22% (p less than 0.05); in cases with an associated cardiac malformation: 45% versus 6% (p less than 0.01) or fibroelastosis: 91% versus 11% (p less than 0.001). None of the patients was lost to follow-up which lasted an average of 47 +/- 41 months. Ten secondary deaths were observed, of which 4 were sudden, 4 after reoperation and 2 due to mitral stenosis with pulmonary hypertension. The overall one year survival was 57% (IC 70%: 40-64); the 5 year survival was 46% (IC 70%; 30-60). Reoperation was necessary in 12 children. Survival without reoperation at 1 and 5 years was 49% (IC 70%: 41-56) and 43% (IC 70%: 29-59) respectively. At the last follow-up examination, 97% of the 23 survivors had good left ventricular function; the systolic pressure gradient was less than 50 mmHg in two thirds of patients and aortic regurgitation was minimal or absent in three quarters of patients. In critical aortic stenosis in neonates, surgery is associated with a high immediate and secondary mortality. The results at medium term in the survivors are good with respect to symptoms, left ventricular function and obstruction to left ventricular ejection.
Losay
J
J
Centre chirurgical Marie-Lannelongue, Le Plessis-Robinson.
Touchot-Koné
A
A
Bruniaux
J
J
Serraf
A
A
Lacour-Gayet
F
F
Planché
C
C
Binet
J P
JP
D001024:Aortic Valve Stenosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D015996:Survival Rate
Résultats immédiats et à moyen terme de la chirurgie chez le nouveau-né avec sténose aortique.