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Ann Thorac Surg 2005;79:47-51
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Critical Aortic Stenosis in Early Infancy: Surgical Treatment for Residual Lesions After Balloon Dilation

^a Department of Cardiovascular Surgery, Pediatric Cardiac Surgery Unit, University of Padova Medical School, Padova, Italy
^b Department of Pediatrics, University of Padova Medical School, Padova, Italy
^c Department of Anaesthesia, University of Padova Medical School, Padova, Italy

Accepted for publication February 3, 2004.

^* Address reprint requests to Dr Vida, Department of Cardiovascular Surgery, Pediatric Cardiac Surgery Unit, University of Padova Medical School, Via Giustiniani, 2-35128 Padova, Italy
vladimirovida{at}interfree.it

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.

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James Monro
Ann. Thorac. Surg. 2005 79: 51-52. [Extract] [Full Text] [PDF]

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