Surgical Treatment of Congenital Aortic Stenosis

¹ Mayo Clinic and Mayo Foundation: Section of Surgery, Mayo Craduate School of Medicine (University of Minnesota)
² Rochester: Resident in Thoracic Surgery
³ Rochester: Resident in Surgery
⁴ Mayo Clinic and Mayo Foundation: Section of Pediatrics, Mayo Craduate School of Medicine (University of Minnesota)

Experience with 169 patients less than 25 years old and operated on at the Mayo Clinic for congenital aortic stenosis is reviewed. Aortic valvotomy is primarily a palliative procedure, allowing adequate relief of the transaortic valve gradient in only 56 percent of patients and leaving a severe gradient in 20 percent. A low operative mortality justifies its use in patients having valid cardiac disability and left ventricular "strain" on the electrocardiogram or even in asymptomatic younger patients in whom the gradient is 75 mm Hg or greater. Infants who have cardiac failure should also be operated on, the risk apparently not being significantly greater in this age group (no deaths in seven operations). The results of valvotomy in older patients (over 16 years of age) were poorest, and operation on asymptomatic patients in this age group seems unwarranted. The objective of aortic valvotomy should be to achieve as great an opening as possible by incision of fused commissures but avoiding incision of raphae because of the risk of producing aortic insufficiency. Supravalvular aortic stenosis and localized fibromuscular subaortic stenosis can be relieved more adequately and permanently by operation than can valvular aortic stenosis, and operation is therefore indicated even in asymptomatic patients if the gradient is about 50 mm Hg or greater.