Document Type : original article

Authors

1 Pediatric cardiology Department, Pediatric Health research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Pediatric Health research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

3 Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.

4 Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Background: Aortic valve stenosis is a relatively common disorder, and many patients undergo surgical treatment annually. Thus, this study was designed to assess the results of aortic valve replacement in Tabriz’s referral hospital from 2006 to 2018.
Methods: Children aged 1 month to 15 years who were diagnosed with congenital aortic valve stenosis and undergone valvular surgery, were included. Based on the findings of echocardiography, the extent of remaining aortic stenosis and aortic insufficiency were evaluated and compared according to different types of surgery, immediately after the surgery and during the 6 months of follow-up. Finally, the results were analyzed comparing the morbidity and mortality of surgical methods.
Results: Among the included patients, 73.8% had left ventricular outflow stenosis at one level, and the remaining had more than one level of stenosis. Prior to surgery, 82.2% of patients had severe ventricular outflow tract stenosis. Immediately after surgery, 91.25% of the patients had no stenosis, or showed mild stenosis. The overall mortality of the operations was 5%. Six months after surgery, only 20% of the patients showed moderate-to-severe stenosis. Web resection and myomectomy showed higher insufficiency rates, and commissurotomy showed increased insufficiency and stenosis. Benthal surgery was shown to reduce remaining rates of insufficiency. Also, a correlation was observed between the mortality rate and commissurotomy surgery. There was no significant relationship between mortality and different levels of aortic stenosis.
Conclusion: The overall success rate of surgery in aortic valve stenosis was acceptable. As different surgical methods implemented in aortic valve stenosis have their own specific pros and cons, regular pediatrician visits are necessary to map-out any possible future complications.

Keywords

  1. Brown JW, Stevens LS, Holly S, Robison R, Rodefeld M, Grayson T, Marts B, Caldwell RA, Hurwitz RA, Girod DA, et al. Surgical spectrum of aortic stenosis in children: a thirty-year experience with 257 children. The Annals of thoracic surgery. 1988; 45(4):393-403.
  2. Salomon NW, Stinson EB, Oyer P, Copeland JG, Shumway NE. Operative treatment of congenital aortic stenosis. The Annals of Thoracic Surgery. 1978; 26(5):452-60.
  3. Singh GK. Congenital Aortic Valve Stenosis. Children (Basel, Switzerland). 2019; 6(5).
  4. Kaden JJ, Eckert JP, Poerner T, Haghi D, Borggrefe M, Pillich M, Harrar-Haag J, Kosinski C, Ortlepp JR. Prevalence of atherosclerosis of the coronary and extracranial cerebral arteries in patients undergoing aortic valve replacement for calcified stenosis. Journal of Heart Valve Disease. 2006; 15(2):165.
  5. Karamlou T, Jang K, Williams WG, Caldarone CA, Van Arsdell G, Coles JG, McCrindle BW. Outcomes and associated risk factors for aortic valve replacement in 160 children: a competing-risks analysis. Circulation. 2005; 112(22):3462-9.
  6. Schlein J, Kaider A, Gabriel H, Wiedemann D, Hornykewycz S, Simon P, Base E, Michel-Behnke I, Laufer G, Zimpfer D. Aortic Valve Repair in Pediatric Patients: 30 Years Single Center Experience. The Annals of Thoracic Surgery. 2023; 115(3):656-62.
  7. Alsoufi B. Aortic valve replacement in children: Options and outcomes. Journal of the Saudi Heart Association. 2014; 26(1):33-41.
  8. Wang K, Zhang H, Jia B. Current surgical strategies and techniques of aortic valve diseases in children. Translational pediatrics. 2018; 7(2):83-90.
  9. Liu C-W, Hwang B, Lee B-C, Lu J-H, Meng L. Aortic stenosis in children: 19-year experience. Zhonghua yi xue za zhi= Chinese medical journal; Free China ed. 1997; 59(2):107-13.
  10. Brown JW, Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW. Surgery for aortic stenosis in children: a 40-year experience. The Annals of thoracic surgery. 2003; 76(5):1398-411.
  11. Brown JW, Ruzmetov M, Vijay P, Turrentine MW. Surgical repair of congenital supravalvular aortic stenosis in children. European journal of cardio-thoracic surgery. 2002; 21(1):50-6.
  12. Alexiou C, Chen Q, Langley SM, Salmon AP, Keeton BR, Haw MP, Monro JL. Is there still a place for open surgical valvotomy in the management of aortic stenosis in children? The view from Southampton. European journal of cardio-thoracic surgery. 2001; 20(2):239-46.
  13. Hawkins JA, Minich LL, Shaddy RE, Tani LY, Orsmund GS, Sturtevant JE, McGough EC. Aortic valve repair and replacement after balloon aortic valvuloplasty in children. The Annals of thoracic surgery. 1996; 61(5):1355-8.
  14. Witsenburg M, Cromme-Dijkhuis AH, Frohn-Mulder IM, Hess J. Short-and midterm results of balloon valvuloplasty for valvular aortic stenosis in children. The American journal of cardiology. 1992; 69(9):945-50.
  15. Elhedai H, SS SM, Idriss H, Bhattacharya P, AY YM. Surgical valvotomy versus balloon dilatation for children with severe aortic valve stenosis: a systematic review. Future cardiology. 2022; 18(11):901-13.
  16. Saung MT, McCracken C, Sachdeva R, Petit CJ. Outcomes Following Balloon Aortic Valvuloplasty versus Surgical Valvotomy in Congenital Aortic Valve Stenosis: A Meta-Analysis. The Journal of invasive cardiology. 2019; 31(6):E133-e42.