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J Thorac Cardiovasc Surg 2001;122:162-168
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Valve-sparing operation for balloon-induced aortic regurgitation in congenital aortic stenosis

From the Departments of Cardiovascular Surgery,^a Cardiology,^b and Biostatistics,^c Children's Hospital, Harvard Medical School, Boston, Mass.

Received for publication Nov 10, 2000. Revisions requested Dec 13, 2000; revisions received Jan 5, 2001. Accepted for publication Jan 22, 2001. Address for reprints: Richard A. Jonas, MD, Department of Cardiovascular Surgery, The Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (E-mail: richard.jonas{at}tch.harvard.edu).

Abstract

Objective: Aortic regurgitation after balloon dilation of congenital aortic stenosis may be treated with valve repair as an alternative to replacement.
Methods: Charts and echocardiograms of all patients undergoing aortic valve operations after balloon dilation of congenital aortic stenosis at our institution between January 1988 and December 1999 were reviewed.
Results: Twenty-one patients underwent valvuloplasty for predominant aortic regurgitation 9 months to 15 years (mean, 6.1 years) after balloon dilation. The mean ± SD age at the time of the operation was 11 ± 7 years. Aortic regurgitation was caused by a combination of commissural avulsion (10), cusp dehiscence with retraction (9), cusp tear (5), central incompetence (2), perforated cusp (1), or cusp adhesion to the aortic wall (1). Repair techniques included commissural reconstruction with a pericardial patch (8), pericardial patch cusp augmentation (6), primary suture repair (6), raphae release and debridement (4), commissurotomy (4), commissural resuspension with sutures (3), and cusp release (1). There were no deaths. At a mean follow-up of 30.1 months (range, 9 months–8 years), all patients were asymptomatic, and the grade of aortic regurgitation had been significantly reduced (P < .001). Left ventricular end-diastolic dimension z scores and proximal regurgitant jet/aortic anulus diameter ratios were significantly reduced (P < .001) and remained so over time. Freedom from reoperation for late failure was 100%, and overall freedom from reintervention was 80% at 3 years.
Conclusion: Aortic valve repair for balloon-induced aortic regurgitation is reproducible and durable at medium-term follow-up.

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