A. Cobanoglu et Jl. Dobbs, CRITICAL AORTIC-STENOSIS IN THE NEONATE - RESULTS OF AORTIC COMMISSUROTOMY, European journal of cardio-thoracic surgery, 10(2), 1996, pp. 116-119
Critical aortic stenosis has been a challenging congenital heart defec
t in the neonate commonly due to severe circulatory failure and multip
le organ dysfunction. Since January, 1982, 20 neonates with a mean age
of 5.6+/-1.6 days and weight of 3.25+/-0.1 kg underwent aortic commis
surotomy, Early surgical intervention, cardiopulmonary bypass with hyp
othermia at 30 degrees C, careful assessment of the aortic leaflets, c
ommissures and sinuses, and extensive commissurotomy short of causing
aortic regurgitation, were essential principles of the operation. Ther
e were three operative deaths (15.0%) and three late deaths. One-year
and 7-year survival. rates are 74+/-10% and 69+/-11%. There were five
reoperations for recurrent stenosis and two of these are late deaths.
At 7 years 80+/-11% of patients remain free of a reoperation. Growth c
urves of survivors have been excellent with only two patients below th
e 5th percentile for both height and weight; 80% of the patients are t
otally asymptomatic. Despite substantial improvements in the treatment
s of most heart defects in neonates in the past decade, critical aorti
c stenosis still carries a malignant behavior with significant early m
ortality and the need for reoperations. Close follow-up of the patient
s is essential due to recurrence of the stenosis and progressive left
ventricular hypertrophy, even when patients are totally asymptomatic.