Surgical commissurotomy of the aortic valve: Outcome of open valvotomy in neonates with critical aortic stenosis

Critical aortic stenosis in the neonate. Clinical assessment and surgical outcome in 18 patients

“…It may be required in the near future in an additional 6 out of the 12 patients because they already show moderate aortic restenosis with a mean transaortic pressure gradient of 60mmHg. This occurred in the group operated upon and in the other that underwent dilation through balloon catheter, according to studies already published 2,3,5,6,9,11 . The risk of aortic regurgitation may be higher in the group undergoing the interventionist procedure through balloon catheter, but general evolution has been shown to be similar for both therapeutic managements 3,5,6,7,9,[11][12][13] .…”

“…The risk of aortic regurgitation may be higher in the group undergoing the interventionist procedure through balloon catheter, but general evolution has been shown to be similar for both therapeutic managements 3,5,6,7,9,[11][12][13] . After the neonatal period some features, such as aortic restenosis, aortic regurgitation, arrhythmias, and syncopes occurring in patients who underwent either surgery or balloon catheter dilation, increase long-term morbidity 2,3,[5][6][7]9,[11][12][13] . The reintervention indices are high in any of the procedures, corroborating the severity of the valvar anomaly that becomes manifest in the neonatal period.…”

“…Intervention is mandatory even though controversy exists in regard to the most adequate treatment: surgery [2][3][4][5][6] or balloon [7][8][9][10][11][12][13] (table I).…”

“…According to a series of experiments, mortality seems to relate more to the unfavorable anatomical type of the left side of the heart, mainly the size of the aortic and mitral rings, the size of the left ventricle (LV), and any associated defects including endocardial fibroelastosis, rather than to the type of treatment chosen [1][2][3][4][11][12][13] . We provide here short-and long-term outcomes of our experience in the surgical treatment of aortic stenosis, contributing to the literature that shows different results in the use of one or the other type of treatment [2][3][4][5][6][7][8][9][10][11][12][13] .…”

Congenital Aortic Stenosis in Childhood

“…Both the reduction of the transaortic gradient (53-67%) and the creation of significant aortic regurgitation (8-21%) after the surgical valvotomy are similar to those described for the valvoplasty technique (Alexiou et al, 2001;Brown et al, 2003;Miyamoto et al, 2006;Zafra et al, 1993). Early mortality after neonatal surgical aortic valvotomy was very high in the early experience but was significantly reduced in subsequent publications, with rates varying between 2.1% and 18% (Alexiou et al, 2001;Bhabra et al, 2003;Brown et al, 2003;Gildein et al, 1996;Hawkins et al, 1998;Miyamoto et al, 2006;Zain et al, 2006). Several risk factors for increased operative mortality include endocardial fibroelastosis, hypoplastic left ventricle, hypoplastic aortic annulus, associated cardiovascular anomalies, extremely small neonates, earlier era surgery, monocuspid aortic valve and impaired left ventricular function (Bhabra et al, 2003;Brown et al, 2006;Hawkins et al, 1998;Miyamoto et al, 2006).…”