Extended aortic valvuloplasty: A new approach for the management of congenital valvar aortic stenosis

https://doi.org/10.1016/0003-4975(91)90972-SGet rights and content

Abstract

A new technique for the treatment of congenital valvar aortic stenosis is described. It consists of augmenting the aortic cusp by extending the commissurotomy incision into the aortic wall around the leaflet insertion, mobilizing the valve cusp attachment at the commissures, and freeing the aortic insertion of the rudimentary commissure. The results of standard valvotomy performed on 48 patients (group 1) were compared with those of the new extended valvuloplasty carried out on 16 patients (group 2). The two groups were comparable in age at operation (2.7 ± 2.1 years for group 1 versus 24 ± 1.7 years for group 2; p = not significant) and in preoperative pressure gradient (58 ± 25 mm Hg for group 1+ versus 61 ± 36 mm Hg for group 2; p = not significant). There was no operative mortality in either group. Follow-up is available on all patients, with a mean of 4.3 ± 2.6 years for group 1 versus 1.7 ± 0.5 years for group 2 (p = 0.05). There was one late death in group 1. Postoperative gradient was 47 ± 13 mm Hg in group 1 versus 19 ± 13 mm Hg in group 2 (p = 0.05). Moderate or severe regurgitation was present in 18 patients (38%) in group 1 and 2 patients (13%) in group 2 (p = not significant). Reoperation was needed in 8 patients (17%) in group 1 versus 2 patients (13%) in gronp 2 (p = not significant). The described valvuloplasty procedure addresses the unique pathological features of valvar aortic stenosis and provides better relief of the obstruction than the presently available techniques. Longer follow-up is needed to determine the late results of this approach.

References (16)

There are more references available in the full text version of this article.

Cited by (23)

  • Selective tricuspidization and aortic cusp extension valvuloplasty: Outcome analysis in infants and children

    2010, Annals of Thoracic Surgery
    Citation Excerpt :

    The concentration and duration of treatment with glutaraldehyde did change during the study period. Currently, a 0.625% glutaraldehyde solution for a shorter duration (3 minutes) is used, compared with our early experience [22]. This might promote increased pericardial pliability and minimizes the incidence of excessive stiffness and early calcification of the reconstructed cusps.

  • Discussion

    2010, Annals of Thoracic Surgery
    Citation Excerpt :

    The concentration and duration of treatment with glutaraldehyde did change during the study period. Currently, a 0.625% glutaraldehyde solution for a shorter duration (3 minutes) is used, compared with our early experience [22]. This might promote increased pericardial pliability and minimizes the incidence of excessive stiffness and early calcification of the reconstructed cusps.

  • Aortic cusp extension valvuloplasty with or without tricuspidization in children and adolescents: Long-term results and freedom from aortic valve replacement

    2010, Journal of Thoracic and Cardiovascular Surgery
    Citation Excerpt :

    In our early series, the pericardial extensions were often heavily calcified and contracted, presumably contributing to progressive post-ACEV aortic valve dysfunction. Currently, the pericardium is treated with 0.625% glutaraldehyde solution for shorter duration (3 minutes), compared with our early experience,20 and kept moist with normal saline. This might promote increased pericardial pliability and decrease the incidence of restenosis; however, the effect of this modification has yet to be determined.

  • Outcome of aortic valve repair in children with congenital aortic valve insufficiency

    2004, Journal of Thoracic and Cardiovascular Surgery
    Citation Excerpt :

    There must be enough leaflet tissue of satisfactory quality to allow restoration of normal coaptation. Aortic valve repair with cusp extension with autologous or bovine pericardium has been described, with what seems excellent initial success.8-10 Long-term results, however, are not yet available.

View all citing articles on Scopus
View full text