EXTENDED AORTIC VALVULOPLASTY FOR RECURRENT VALVULAR STENOSIS AND REGURGITATION IN CHILDREN

Recurrent significant aortic valvular stenosis or regurgitation, or bo th, after balloon or open valvotomy in pediatric patients often necess itates aortic valve replacement. In an attempt to preserve the aortic valve, we performed extended aortic valvuloplasty in 21 children with recurrent aortic valve stenosis or regurgitation from January 1989 to March 1993. Previous related procedures were one open aortic valvotomy or more (n = 15), balloon valvotomy (n = 4), balloon valvotomy after surgical valvotomy (n = 1), and repair of iatrogenic valve tear (n = 1 ). Mean age at the time of the extended aortic valvuloplasty was 6 +/- 3.4 years. Mean pressure gradient across the aortic valve was 56 +/- 12 torr. Regurgitation was moderate (grade 2 to 3) in nine and severe (grade 4) in 12 patients. Extended aortic valvuloplasty techniques con sisted of thinning of valve leaflets (n = 15), augmentation of scarred and retracted leaflets with autologous pericardium (n = 11), resuspen sion of the augmented leaflet (n = 14), release of the rudimentary com missure from the aortic wall (n = 5), extension of the valvotomy incis ion into the aortic wall on both sides of the commissure (n = 20), pat ch repair of the sinus of Valsalva perforation (n = 1), reapproximatio n of tears (n = 5), and narrowing of the ventriculoaortic junction (n = 2). No operative deaths occurred. The postoperative mean pressure gr adient, assessed by most recent Doppler echocardiography or cardiac ca theterization at a follow-up of 18 +/- 6 months, was 19 +/- 6 torr (p < 0.01 versus the preoperative gradient). Aortic regurgitation was abs ent in 13, mild in 6, and moderate-to-severe, necessitating subsequent aortic valve replacement, in 2. This short-term experience indicates that extended aortic valvuloplasty is a safe and effective surgical ap proach that minimizes the need for aortic valve replacement in childre n with significant recurrent aortic valve stenosis or regurgitation.