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J Thorac Cardiovasc Surg 2008;135:552-559
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Surgical aortic valvuloplasty in children and adolescents with aortic regurgitation: Acute and intermediate effects on aortic valve function and left ventricular dimensions

^a Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Mass
^b Department of Cardiology, Children's Hospital Boston and Harvard Medical School, Boston, Mass
^c Division of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Tex
^d Division of Cardiovascular Surgery, Children's National Medical Center, Washington, DC

Received for publication July 17, 2007; revisions received September 11, 2007; accepted for publication September 26, 2007.

^_* Address for reprints: Doff B. McElhinney, MD, Department of Cardiology, Children's Hospital, Boston, MA 02115. (Email: doff.mcelhinney{at}cardio.chboston.org).

Objective: Surgical aortic valvuloplasty is increasingly employed in the management of children and adolescents with aortic regurgitation, but the durability of this approach and factors associated with outcome are not well defined.

Methods: From 1989 to 2005, a total of 81 patients younger than 19 years with moderate or severe aortic regurgitation underwent surgical aortic valvuloplasty. Aortic regurgitation was congenital in 20 cases, after treatment of aortic stenosis in 30, from other injuries to the aortic valve in 12, and from other causes in 19. Eighteen patients had moderate or severe aortic stenosis. Preoperative left ventricular end-diastolic dimension z score was 4.9 ± 2.7.

Results: After surgical aortic valvuloplasty with various techniques, including pericardial leaflet augmentation in 80%, aortic regurgitation was improved in 77 patients and was mild or less in 68. Ten of 18 patients with moderate or severe aortic stenosis before repair had a decrease to mild, whereas 2 had progression from mild to moderate. Left ventricular end-diastolic dimension z score decreased by 2.9 ± 2.1 (P < .001). During follow-up (median 4.7 years), 33 patients underwent aortic valve reinterventions, including aortic valve replacement in 25. Estimated freedoms from aortic valve replacement were 72% ± 6% at 5 years and 54% ± 9% at 7.5 years and were shorter in patients with moderate or severe aortic stenosis before surgical aortic valvuloplasty. Among surviving patients who did not undergo aortic valve replacement, aortic regurgitation at follow-up was moderate in 21 and trivial or mild in 34; left ventricular and aortic root dimensions were preserved.

Conclusion: Surgical aortic valvuloplasty is a valid option with good intermediate results for children and adolescents with aortic regurgitation from a variety of causes, particularly for patients with less than moderate aortic stenosis.