Valvular aortic stenosis in children. Long-term results of surgical valvuloplasty

From 1960 through 1992, 67 children with congenital aortic stenosis aged 6- 228 months (M 105.7 +/- 52) were submitted to aortic valvuloplasty at our i nstitution. There was no hospital mortality. During the follow-up of 127.5 +/- 66.7 months, there were two late valve related deaths. Eight patients ( 11.9 %) developed aortic regurgitation 5 to 125 months (M 66.6 +/- 35) foll owing surgical valvuloplasty and one of them required aortic valve replacem ent. Because of restenosis, 15 patients required a second operation. Of the m five children underwent a second aortic valvuloplasty without mortality a nd, in four of them, the functional result has been excellent after a mean follow-up of 75.4 +/- 12 months. Ten patients required an aortic valve repl acement 62 to 208 months post-op (M 100.9 +/- 50.8). Mechanical prosthesis were used in 6 and bioprosthesis in 4. Two patients required a Konno and on e patient a Ross procedure. There were no early nor late deaths following r eoperations. The 20 year survival rate following the first valvuloplasty wa s 94%, the freedom from reoperation 63% and the freedom from aortic valve r eplacement 73% for the same time period. Our results demonstrate that conge nital aortic valvar stenosis in children can be surgically well controlled until adulthood. Our study also illustrates that surgical valvuloplasty is a safe and efficacious procedure and that its benefical effect is maintaine d over 20 years in the majority of children.