Aortic stenosis surgery in infancy.

During the past 14 years, 28 infants (23 males) underwent valvotomy for severe aortic stenosis at the Children's Hospital Medical Center in Boston. The median age was two months and the oldest patient was six months old. Congestive heart failure was present in all but two babies. Preoperatively, the electrocardiogram was abnormal in all, with left ventricular hypertrophy and a strain pattern being present in 19. At cardiac catheterization, the peak systolic ejection gradient (PSEG) ranged from 35-130 mm Hg (median 90 mm Hg). Associated cardiac lesions were present in 39%. Twenty-four infants underwent valvotomy with inflow occlusion. Four patients were operated upon using cardiopulmonary bypass. There were eight early and two late deaths. The 18 survivors have been followed from six months to 11 years (median five years). Only four are symptomatic. Mild aortic regurgitation developed postoperatively in six patients, moderate in one and severe enough to require valve replacement in another one. The electrocardiogram improved postoperatively in 15 patients, but became entirely normal only in one. Five children required a repeat valvotomy for residual stenosis 1-10 years after the original procedure (median four years). At this second operation, the majority of the valves were flexible and noncalcified, and valvotomy was accomplished without difficulty. One child who underwent valve replacement for aortic regurgitation at age two years is well seven years later.