CRITICAL AORTIC-STENOSIS IN THE NEONATE - RESULTS OF AORTIC COMMISSUROTOMY

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.