Critical aortic stenosis in early infancy: surgical treatment for residual lesions after balloon dilation.
BACKGROUND
The optimal management for critical aortic stenosis in early infancy continues to challenge cardiologists and cardiac surgeons. We present a review of our experience with the surgical treatment of residual aortic valve disease after percutaneous balloon dilation for critical aortic stenosis in early infancy.


METHODS
Since 1989, 11 of the 38 patients who survived aortic balloon dilation (28.9%) have undergone surgical treatment for residual aortic valve dysfunction. Median time from aortic balloon dilation to surgical intervention was 7 months (range 1 to 56 months). Residual aortic stenosis was the predominant problem in 8 patients and aortic regurgitation was predominant in 2 patients.


RESULTS
Aortic valvuloplasty was possible in 5 children; pulmonary autograft replacement of the aortic valve was performed in 6 children. Two children underwent a Ross-Konno procedure because of annulus hypoplasia and severe left ventricular outflow tract obstruction. Two early deaths occurred after a Ross-Konno procedure, both with findings of severe left ventricular fibroelastosis at the pathologic examination. Median follow-up time was 5 years (range 1 month to 11.9 years). No late deaths occurred. One patient with moderate-severe aortic valve regurgitation after aortic valvuloplasty underwent a successful Ross operation. All 9 patients are asymptomatic and are in good clinical condition.


CONCLUSIONS
We are convinced that the best aortic valve in the pediatric age group is the native one, provided it can function acceptably. However, in cases where conservative surgical treatment fails to yield a functional aortic valve, replacement of the valve is indicated, and the best aortic valve substitute in infants is the pulmonary autograft because of its potential for growth.
Vida
Vladimiro L
VL
Department of Cardiovascular Surgery, Pediatric Cardiac Surgery Unit, University of Padova Medical School, Padova, Italy. vladimirovida@interfree.it
Bottio
Tomaso
T
Milanesi
Ornella
O
Reffo
Elena
E
Biffanti
Roberta
R
Bonato
Raffaele
R
Stellin
Giovanni
G
D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D001705:Bioprosthesis; D002404:Catheterization / Q000379:methods; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004695:Endocardial Fibroelastosis / Q000209:etiology; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000209:etiology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011664:Pulmonary Valve / Q000637:transplantation; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014463:Ultrasonography; D014693:Ventricular Fibrillation / Q000209:etiology; D014694:Ventricular Outflow Obstruction / Q000601:surgery