Treatment of valvular aortic stenosis in children: a 20-year experience in a single institution

Abstract

Surgical valvotomy of aortic stenosis in this long-term follow-up study resulted in no 30-day mortality and <1% late mortality. Reinterventions were common, with 38% of the patients having further surgery or catheter treatment of the aortic valve before the age of 18 years. Among the 40 patients aged 18 years or older at follow-up, 45% had had the aortic valve replaced. Our data do not allow comparison of catheter and surgical treatment, but, based on these results, we find no reason to change our current policy of surgical treatment as 1st intervention in patients with isolated valvular aortic stenosis.

Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle

“…Among others, severe left ventricular dysfunction is a risk factor for AV surgery following neonatal BAV, according to Kido et al [31]. However, the time gained until the first surgery is worthwhile because patients with congenital AV stenosis are exposed to a high mortality risk for multiple AV operations, including AV reconstruction, the Ross procedure, or AV prosthesis [32][33][34][35][36]. Thus, future perioperative risks due to typical intrathoracic adhesions [37,38] might be reduced by postponing surgery to later childhood.…”

Balloon Valvuloplasty In Congenital Critical Aortic Valve Stenosis – A Rescue Procedure For The Left Ventricle

“…Among others, severe left ventricular dysfunction is a risk factor for AV surgery following neonatal BAV according to Kido et al [25]. However, the gain of time until first surgery is worthwhile because patients with congenital AV stenosis are exposed to a high life-time risk for multiple AV operations including AV reconstruction, Ross procedure or AV prosthesis [26][27][28][29][30]. Thus, future perioperative risks due to typical intrathoracic adhesions [31,32] might be reduced by postponing surgery to later childhood.…”

Children and Adolescents Treated for Valvular Aortic Stenosis Have Different Physical Activity Patterns Compared to Healthy Controls: A Methodological Study in a National Cohort

“…Due to the relatively small sample and the novelty of the methods and findings, it is too early to draw definitive conclusions concerning the clinical implications of the present study. Children and adolescents treated for VAS may have specific limitations of performing PA [6,9,10]. Therefore, it is recommended that individually adapted PA determined from the clinical assessment may be prescribed (e.g., Physical Activity on Prescription), targeting also other barriers that may occur (e.g., low self-efficacy, overprotection, and restrictions from parents) [11][12][13].…”

“…In Sweden, the primary treatment is surgical valvotomy. As VAS is a complex and lifelong disease where re-interventions and further surgery is common [ 9 ], patients often show residual or acquired abnormalities of the left heart structure which might affect cardiovascular capacity [ 10 ]. Even if exercise function is preserved in most patients treated for VAS in infancy, there may still be reduced peak VO 2 in some individuals, probably reflecting inability to increase stroke volume [ 6 ].…”