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Long-term follow-up of treated critical aortic stenosis

Published online by Cambridge University Press:  19 August 2008

Denise Kitchiner ,
Narayanswami Sreeram ,
Nilima Malaiya ,
Mark Jackson ,
Kevin Walsh ,
Ian Peart  and
Robert Arnold
Denise Kitchiner
Affiliation:
Royal Liverpool Children's NHS Trust, Liverpool
Narayanswami Sreeram
Affiliation:
Royal Liverpool Children's NHS Trust, Liverpool
Nilima Malaiya
Affiliation:
Royal Liverpool Children's NHS Trust, Liverpool
Mark Jackson*
Affiliation:
From the Cardiac Unit and Institute of Child Health
Kevin Walsh
Affiliation:
Royal Liverpool Children's NHS Trust, Liverpool
Ian Peart
Affiliation:
Royal Liverpool Children's NHS Trust, Liverpool
Robert Arnold
Affiliation:
Royal Liverpool Children's NHS Trust, Liverpool
*
Dr. D. Kitchiner, Cardiac Unit, Royal Liverpool Children's NHS Trust, Eaton Road, Liverpool LI2 2AP, United Kingdom. Tel. 4451 228-4811, Ext. 2710; Fax. 44 51 228-0328.
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Summary

To determine the long-term results in patients with critical aortic stenosis who survive initial intervention, and to identify factors which predict prognosis, we studied patients who underwent intervention between 1979 and 1992 for critical aortic stenosis treated within the first three months of life. Patients with a hypoplastic left ventricle or mitral stenosis who were not considered for a biventricular repair were excluded. Follow-up examination included cross-sectional and Doppler echocardiography. All initial and subsequent patient data were reviewed. Of the 64 patients with critical aortic stenosis, 41 (64%) survived more than one month after initial intervention (surgical valvotomy in 39, balloon valvoplasty in two). These survivors constitute the study group. Mild or moderate residual aortic stenosis or regurgitation without further intervention was found in 28 patients at a median duration of 3.1 years (range 0.2–15.0 years). A poor result with re-intervention (n=6) or death (n=7) occurred in 13 patients. The diameter of the aortic valve at presentation was smaller (p<0.02) in patients with a poor result (median 5.5; range 5–15 mm), than in those with a satisfactory result (median 8.0; range 5–10 mm). Significant residual aortic stenosis was present from the time of initial intervention in nine of the 13 patients (69%) with a poor result. No difference was found in the incidence of a duct-dependent systemic circulation, associated cardiac lesions, mechanical ventilation, acidosis or the use of inotropes preoperatively between patients with a satisfactory or a poor late outcome. Of patients with critical aortic stenosis, 64% survived for more than a month after initial intervention. A small aortic valvar diameter at presentation ( 6 mm) and residual stenosis after initial intervention were important determinants of long-term prognosis.

Keywords

Aortic stenosiscriticalprognosis
Type
Original Articles
Information
Cardiology in the Young , Volume 5 , Issue 1 , January 1995 , pp. 9 - 14
Copyright
Copyright © Cambridge University Press 1995

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