Congenital aortic stenosis. Early and late results of aortic valvulotomy.

Between 1962 and 1979, 87 patients with congenital aortic stenosis (11 infants from 4 days to 5 months, and 76 patients from one year to 24 years) underwent open aortic valvulotomy; in 14 patients an additional subvalvular membraneous ring or hypertrophic subaortic stenosis was resected. There were 3 early deaths (3%), all in infants less than one year of age. A second operation was necessary 3 months to 10 years (mean 6.3 +/- 4 years) after the initial procedure in 12 of the 84 survivors. In 9 patients an aortic valve replacement and in 3 patients a second valvulotomy was performed without perioperative mortality: in the latter group valve replacement had to be performed later. There were 5 late deaths (6%). The causes of death were endocarditis (2), thrombosis of the prosthesis (1), accident (1) and sudden death (1). The overall actuarial survival curve shows a 5-year survival of 90% and a 10-year survival of 87%; 87% are reoperation-free after 5 years and 75% after 8 years. At present 7 patients are scheduled for surgery because of recurrence of stenosis; 61 patients are symptom-free. It is concluded that aortic valvulotomy has immediate and long-term benefit in the large majority of patients. Operative mortality and morbidity are low in patients older than one year of age. Nevertheless aortic valvulotomy, which should not be performed too late, represents a palliative treatment and will lead to reoperation in approximately 25% of patients after 8 years.