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

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.