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J Thorac Cardiovasc Surg 1999;118:503-509
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

EXTENDED AORTIC ROOT REPLACEMENT WITH AORTIC ALLOGRAFTS OR PULMONARY AUTOGRAFTS IN CHILDREN

From the Division of Cardiovascular Surgery, Department of Surgery,^a and the Division of Paediatric Cardiology, Department of Paediatrics,^b The Hospital for Sick Children and the University of Toronto Faculty of Medicine,^a,b Toronto, Ontario, Canada.

Address for reprints: Hani K. Najm, MD, Assistant Professor and Consultant of Cardiac Surgery, Department of Surgery, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia.

Objectives: To evaluate the early results and effectiveness of left ventricular outflow tract enlargement with aortic allograft or pulmonary autograft in children with complex left ventricular outflow tract obstruction.
Method: The records of 30 children who underwent aortic root enlargement and replacement with either an aortic allograft (22 patients) or pulmonary autograft (8 patients) between January 1987 and June 1997 were reviewed. The predominant diagnosis was complex left ventricular outflow tract obstruction (n = 19), associated with aortic incompetence in 11 children. Before root enlargement, 27 children underwent surgical valvotomy (14 patients), balloon dilatation (10 patients), or both interventions (3 patients). Mean age at root enlargement was 5.4 ± 3.5 years (range, 2 days–16 years). Most of the children (27 patients) underwent a Konno aortoventriculoplasty. Concomitant septal myectomy was performed in 4 children, mitral valve procedure in 5 children, and endocardial fibroelastosis resection in 1 child.
Results: Five children (17%) died in hospital. Four of these were infants less than 2 months old. All had acute aortic incompetence as the result of recent intervention necessitating urgent operation. The fifth child, aged 10 years, died of myocardial failure 2 weeks after the operation. During the follow-up period (mean length, 4.1 ± 2.8 years), sudden death occurred in 1 child 3 months after the operation. Follow-up echocardiograms (obtained for 23 of the surviving 24 children within 3 ± 2.3 years) showed a left ventricular outflow tract gradient reduced from a mean of 65 to 11 mm Hg (P = .001); Z value increased from a mean of –0.5 to 4.1 (P < .001), and aortic incompetence was trivial or mild except in 2 children.
Conclusion: Urgent aortic root enlargement in decompensating neonates carries higher mortality rates. In older children, the early results of root enlargement and implantation of allograft or autograft are good.

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