SURGICAL COMMISSUROTOMY OF THE AORTIC-VALVE - OUTCOME OF OPEN VALVOTOMY IN NEONATES WITH CRITICAL AORTIC-STENOSIS

Early intervention is necessary in neonates with critical aortic steno sis, The advent of alternate therapy, particularly balloon aortic valv uloplasty, requires a reappraisal of the traditional surgical approach , including the efficacy of initial transvalvar gradient reduction and freedom from recurrence of obstruction in the longer term, This repor t describes a series of 33 consecutive infants who underwent surgical aortic valvotomy in the first month of life, The hospital mortality wa s 18% with a 5-year probability of survival of 66% (90% CI, 50% to 79% ), Fourteen reinterventions, nine reoperations and five balloon dilata tions, were required at a median age of 0.8 years (range 9 days to 6 y ears), Three patients died after reintervention (one early and two lat e), The median follow-up time was 5.8 years (range 0.2 to 14 years), A t last follow-up Doppler investigation the average Doppler mean and pe ak gradients were 34 mm Hg and 18 mm Hg, respectively, Open valvotomy in neonatal aortic valve stenosis allows the use of an appropriate sur gical approach with low initial mortality and satisfactory 5-year free dom from reintervention.