title: Late results of aortic valvotomy for congenital valvar aortic stenosis.
abstract: Fifty-one patients, aged 1 to 18 years, having aortic valvotomy for congenital valvar aortic stenosis between 1956 and 1986 were followed up. The average age at operation was 11.5 years, with an operative mortality of 3.9%. The aortic valve gradient decreased from a mean preoperative value of 91 mm Hg to 27 mm Hg postoperatively. Current follow-up was 90% and averaged 16.8 years. Late cardiac mortality was 17.6%, with actuarial survival of 93.7% at 10 and 15 years, 81.8% at 20 and 25 years, and 70.9% at 28 years. Nineteen patients required reoperation (39%) at a mean of 17.7 years postoperatively, with a reoperation-free survival of 98% at 10 years. The reoperation rate accelerated in the following decade to 3.3% per year. Ten patients without reoperation were evaluated by continuous-wave Doppler echocardiography. The mean gradient was 21.6 mm Hg, and 90% had mild to moderate aortic insufficiency. This study confirms the efficacy of valvotomy in this age group and suggests that long-term survival and time to reoperation may be longer than previously reported.
authors.affiliation: Surgery Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892.
authors.forename: D A
authors.initials: DA
authors.lastname: DeBoer
authors.forename: R C
authors.initials: RC
authors.lastname: Robbins
authors.forename: B J
authors.initials: BJ
authors.lastname: Maron
authors.forename: C L
authors.initials: CL
authors.lastname: McIntosh
authors.forename: R E
authors.initials: RE
authors.lastname: Clark
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000503:physiopathology / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D015996:Survival Rate; D013997:Time Factors