Long-term evaluation of aortic valvotomy for congenital aortic stenosis

K. J. Tveter, J. E. Foker, J. H. Moller, W. S. Ring, C. W. Lillehei, R. L. Varco

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Aortic valvotomy (AV) for relief of congenital aortic stenosis (AS) is a palliative operation, and the purpose of this study was to determine the long-term benefit. After analyzing the symptoms at time of operation, 177 patients were separated by age at AV: newborns (1-14 days) 26, infants (2 weeks-1 year) 19, and children (≥1 year) 132. The newborn with critical AS typically presents with severe cardiac failure and the infant with moderate failure, whereas children may be asymptomatic. In the newborn group, final diagnosis has been made exclusively by noninvasive cardiac echogram since 1984. The presence of a hypoplastic left ventricle (HLV) and/or endocardial fibroelastosis (EFE) are the most important determinants of mortality. Operative survival was 11 of 13 (85%) in the newborn group if HLV/EFE were not present. No operative deaths for AV occurred after 1965 in children. When present, a preoperative electrocardiographic strain pattern resolved in 80% of patients. Of 33 reoperations (21%), four were required 1.0 (0.5-2) years later for newborns, five were required for infants 7.2 (1.5-20) years later, and 24 were required in children 11.0 (1.5-25) years later. These included 10 repeat valvotomies and 23 aortic valve replacements (AVRs) with a 91% survival rate. In summary, although valves of patients with congenital AS are morphologically abnormal, valvotomy is beneficial. It was found that (1) the operative survival rate has been 100% over the past 20 years for children and currently is greater than 80% in newborns in the absence of HLV/EFE; (2) reoperation rate is higher in newborns and infants; (3) benefit was shown by a sharp decrease in obstruction inititally and improved ECG later; (4) long-term follow-up revealed a subset of patients who are asymptomatic and have only mild residual obstruction over 20 years after AV.

Original languageEnglish (US)
Pages (from-to)496-503
Number of pages8
JournalAnnals of Surgery
Volume206
Issue number4
StatePublished - 1987

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Aortic Valve Stenosis
Newborn Infant
Endocardial Fibroelastosis
Heart Ventricles
Reoperation
Survival Rate
Aortic Valve
Electrocardiography
Heart Failure
Survival
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Tveter, K. J., Foker, J. E., Moller, J. H., Ring, W. S., Lillehei, C. W., & Varco, R. L. (1987). Long-term evaluation of aortic valvotomy for congenital aortic stenosis. Annals of Surgery, 206(4), 496-503.

Long-term evaluation of aortic valvotomy for congenital aortic stenosis. / Tveter, K. J.; Foker, J. E.; Moller, J. H.; Ring, W. S.; Lillehei, C. W.; Varco, R. L.

In: Annals of Surgery, Vol. 206, No. 4, 1987, p. 496-503.

Research output: Contribution to journalArticle

Tveter, KJ, Foker, JE, Moller, JH, Ring, WS, Lillehei, CW & Varco, RL 1987, 'Long-term evaluation of aortic valvotomy for congenital aortic stenosis', Annals of Surgery, vol. 206, no. 4, pp. 496-503.
Tveter KJ, Foker JE, Moller JH, Ring WS, Lillehei CW, Varco RL. Long-term evaluation of aortic valvotomy for congenital aortic stenosis. Annals of Surgery. 1987;206(4):496-503.
Tveter, K. J. ; Foker, J. E. ; Moller, J. H. ; Ring, W. S. ; Lillehei, C. W. ; Varco, R. L. / Long-term evaluation of aortic valvotomy for congenital aortic stenosis. In: Annals of Surgery. 1987 ; Vol. 206, No. 4. pp. 496-503.
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abstract = "Aortic valvotomy (AV) for relief of congenital aortic stenosis (AS) is a palliative operation, and the purpose of this study was to determine the long-term benefit. After analyzing the symptoms at time of operation, 177 patients were separated by age at AV: newborns (1-14 days) 26, infants (2 weeks-1 year) 19, and children (≥1 year) 132. The newborn with critical AS typically presents with severe cardiac failure and the infant with moderate failure, whereas children may be asymptomatic. In the newborn group, final diagnosis has been made exclusively by noninvasive cardiac echogram since 1984. The presence of a hypoplastic left ventricle (HLV) and/or endocardial fibroelastosis (EFE) are the most important determinants of mortality. Operative survival was 11 of 13 (85{\%}) in the newborn group if HLV/EFE were not present. No operative deaths for AV occurred after 1965 in children. When present, a preoperative electrocardiographic strain pattern resolved in 80{\%} of patients. Of 33 reoperations (21{\%}), four were required 1.0 (0.5-2) years later for newborns, five were required for infants 7.2 (1.5-20) years later, and 24 were required in children 11.0 (1.5-25) years later. These included 10 repeat valvotomies and 23 aortic valve replacements (AVRs) with a 91{\%} survival rate. In summary, although valves of patients with congenital AS are morphologically abnormal, valvotomy is beneficial. It was found that (1) the operative survival rate has been 100{\%} over the past 20 years for children and currently is greater than 80{\%} in newborns in the absence of HLV/EFE; (2) reoperation rate is higher in newborns and infants; (3) benefit was shown by a sharp decrease in obstruction inititally and improved ECG later; (4) long-term follow-up revealed a subset of patients who are asymptomatic and have only mild residual obstruction over 20 years after AV.",
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AU - Foker, J. E.

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AU - Varco, R. L.

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