Forty four patients, with a mean age at surgery of 10 yr, were followed for 5 to 16 yr (mean 9.7 yr) after relief of left ventricular outflow tract obstruction. There were no early deaths, but 5 late deaths occurred, 3 following reoperation. Twenty five patients were recatheterized from 1 to 16 yr later (mean 6.6 yr). In 21 of 32 patients (66%), a new diastolic murmur followed relief of valvular stenosis; 25 (78%) of these patients had a postoperative diastolic murmur. Seventeen of these 25 (68%) were recatheterized, and 11 of the 17 (65%) had moderate to severe aortic incompetence on angiography. Eight patients (18%) have undergone reoperation and 9 more (20%) will have to be reoperated upon soon. Although the aortic valve gradient and left ventricular stroke pressure were reduced in all obstructive types after surgery, left ventricular end diastolic pressure significantly increased and cardiac index decreased after valvotomy. Cardiomegaly and electrocardiographic (ECG) abnormalities were present in 45% and 66%, resp. of all postoperative patients. Although 92% of patients may be expected to survive and 82% be reoperation free at 10 yr, further surgery thereafter becomes increasingly common. Timely relief of obstruction prevents sudden death and produces excellent symptomatic improvement, but the operation is only palliative. Development of a reliable pediatric valve and ventriculo aortic conduit may encourage earlier and more aggressive therapy.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine