Authors:
Publish Date: 1991/07/01
Volume: 5, Issue: 7, Pages: 378-382
Abstract
Open commissurotomy for critical aortic stenosis has been performed in aconsecutive series of 28 neonates and infants below 3 months of ageaverage age 1 month including 5 patients with severe organic mitral valvedisease in need of concomitant correction In the majority of cases aorticstenosis was due not only to fused commissures but also to excessiveimmature valve tissue protruding into the valve area Therefore a techniqueof extended commissurotomy has been adopted resecting such nodulesresponsible for a secondary level stenosis All operations were done underdeep hypothermia 17 degrees C circulatory arrest 33 +/ 11 min andcardioplegia using the Bretschneider solution 3550 ml/kg Hospitalmortality was 18 5 including 1 infant dying at 2 months of thrombosedmitral prosthesis inserted at a secondary operation Severe organic mitralvalve disease proved to be the only significant risk factor for earlymortality During the follow up period of up to 10 years average 5years 1 child with a hypoplastic left heart died and 2 children had toundergo reoperation for residual and recurrent stenosis respectivelyActuarial survival for the present series is 78 at 10 years whilereoperation free survival for the aortic valve is 64 It is concluded thatcareful and if necessary extended open commissurotomy still represents themethod of choice in this age group Alternative methods such astransventricular or percutaneous dilatation did not show a lower risk untilnow and longterm results are not convincing as yet
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