Is there a place for pediatric valvotomy in the autograft era?

Objective: Valvotomy and the autograft procedure are the most common surgic al treatment options for children with valvular aortic stenosis. We evaluat ed the results of these surgical procedures in our institution. Methods: Re trospective analysis was done of all patients presenting with aortic stenos is and operated upon before the age of 18. In 11 patients a valvotomy was p erformed and in 36 an autograft procedure. Results: There was no hospital m ortality. Mean follow-up in the valvotomy group was 4.8 years (SD 3.3), in the autograft group 4.5 years (SD 3.3). During follow-up one patient died s uddenly 2 months after valvotomy. Two patients in the autograft group died (not valve-related). After valvotomy three patients underwent a balloon val votomy, in one followed by an autograft procedure and one patient had a rep eat valvotomy. In the autograft group one patient was reoperated for severe aortic regurgitation and moderate pulmonary stenosis. Ar last echocardiogr aphy after valvotomy (eight remaining patients) in only two patients (25%) no aortic stenosis or regurgitation was present. In the remaining six patie nts aortic stenosis is mild in two and moderate in three, including one wit h moderate aortic regurgitation. Tn one patient without stenosis, moderate aortic regurgitation was seen. No pulmonary stenosis or regurgitation is pr esent. Echocardiography after autografting (33 remaining patients) showed n o aortic stenosis. Aortic regurgitation was mild in seven patients, moderat e in two, severe in one. Pulmonary stenosis was present in two patients (16 %). Pulmonary regurgitation was mild in three patients and moderate in one. Conclusions: In selected patients with valvular aortic stenosis who are be yond infancy, valvotomy may be adequate and may postpone further surgery fo r a significant length of time. After valvotomy the main problem is residua l aortic stenosis while after autografting a shift occurs to aortic regurgi tation and problems related to the pulmonary valve. Careful clinical and ec hocardiographic follow-up is therefore warranted in young patients after th e autograft procedure. (C) 2001 Elsevier Science B.V. All rights reserved.