SEVERE AORTIC-VALVE DISEASE AND COARCTATI ON IN ADULTS - PREVALENCE, CLINICS AND LONG-TERM RESULTS OF SURGERY

Severe aortic valve disease is a rare complication of coarctation in a dults. Between 1961 and 1990 aortic valve replacement was performed af ter or combined with the operation of coarctation in 24 adults (4% of entire population operated for coarctation). Bicuspid aortic valves we re present in 2/3, of patients. In 10 patients (7/10 with aortic steno sis) coarctation was operated early (mean age 24 years) and aortic val ve late (mean age 40 years): in 14 (10/14 with aortic regurgitation, m ean age 40 years) aortic valve and coarctation were operated simultane ously (8 patients) or staged within 6 months (6 patients). Additional surgical interventions on the dilated aorta ascendens were performed i n 8, mitral valve replacement in 2 and aorto-coronary bypass in 1 pati ents. Early mortality was 2/24 (8%) and was similar in simultaneously (1/8) and staged (1/14) operated cases: 10 year survival was lower tha n in an age-matched group of 72 patients with aortic valve disease of similar severity operated during the same period (70% vs 88%, p < 0.01 ): 6/7 late deaths were cardiac; 5/5 pts with preoperatively severely increased end-diastolic (> 199 ml/m(2)) and 4/4 with end-systolic (> 9 0 ml/m(2)) left ventricular volumes and 2/2 with ejection fraction < 4 1% died late postoperatively. Severe aortic valve disease arised in 4% of adults with coarctation or after coarctation resection. The result s of valve replacement in these patients were less successful due to h igh late mortality in cases with severe preoperative left ventricular dilatation and/or decrease of ejection fraction. Thus, close surveilla nce of patients after coarctation surgery, especially those with bicus pid valves, is mandatory for early detection of valvular disease and a ppropriate timing of valve replacement before left ventricular functio n begins to deteriorate.