Congenital Aortic Stenosis

Correlation of Clinical and Hemodynamic findings with the Severity of the lesion

¹ Pediatric Cardiology, Sutter Hospitals and the Sutter Medical Research Foundation, Sacramento, California

The correlation of the clinical course and the hemodynamic findings of 41 children with congenital fixed nonmuscular aortic stenosis with the severity of the lesion showed that patients with aortic valve areas less than 16 percent of the predicted normal value for age develop early congestive failure and require early, often emergency, surgery for survival. Patients with aortic valve areas 16 percent to 31 percent of predicted for age have a significant risk of sudden death from exertional syncope and surgery is indicated between age five and ten years. When the aortic valve area is 31 percent to 46 percent of predicted, elective surgery is recommended between age ten and 15 years. Children with aortic valve areas greater than 45 percent of predicted for age have insignificant hemodynamic changes and do not require surgical correction; however, further data is needed in regard to the long-term prognosis of these patients since it is possible that persistent left ventricular overwork may result in irreversible myocardial dysfunction in adult life. Additionally late progressive severity due to calcific aortic valve disease may occur in high incidence.