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J Thorac Cardiovasc Surg 1995;110:565
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

Morphology of critically stenotic aortic valves

Department of Paediatrics
National Heart & Lung Institute
Dovehouse St.
London SW3 6LY, United Kingdom

To the Editor:

The study reported by Mosca and his colleagues ¹ in the January issue of the Journal is an important contribution to the ongoing debate concerning the optimal treatment of critically stenotic aortic valves. It is clear from the reported discussion that the subject generated significant debate when presented at the annual meeting of The American Association for Thoracic Surgery. It seems to me, however, that Dr. Mosca's group failed to address one significant issue, namely, the morphologic characteristics of the stenotic valves.

In his closing comments, Mosca states that dilation "causes rupture of the stenotic valves along the fused commissures." This may be the case for bifoliate and trifoliate valves, but what of the so-called unicuspid and unicommissural valves? In our experience, ² these valves are the majority in autopsied examples of critical aortic stenosis. They are also, probably, the hardest variants to treat, either by surgery or by balloon dilation, because they have an annular attachment of their solitary leaflet with, in consequence, no fused commissures to rupture. Because of the morphologic variability, with its potential consequences for treatment, it is important to know the numbers of each anatomic variant in the reported series. ³ In her response to a previous letter on this topic, Bu'Lock ⁴ emphasized the problems in diagnosing valve morphology preoperatively and pointed to the potential value of transesophageal echocardiography or intravascular ultrasonography. Does the team from Ann Arbor have any information on morphologic characteristics of the valves in their patients treated by surgery as opposed to balloon dilation?

References

1. Mosca RS, Iannettoni MD, Schwartz SM, et al. Critical aortic stenosis in the neonate: a comparison of balloon valvuloplasty and transventricular dilation. J THORAC CARDIOVASC SURG 1995;109:147-54.[Abstract/Free Full Text]
   
2. McKay R, Smith A, Leung MP, Arnold R, Anderson RH. Morphology of the ventriculoarterial junction in critical aortic stenosis. J THORAC CARDIOVASC SURG 1992;104:434-42.[Abstract]
   
3. Anderson RH. Balloon dilatation (valvoplasty) as first line treatment for severe stenosis of the aortic valve in early infancy: medium term results and determinants of survival [Letter]. Br Heart J 1994;72:300.
   
4. Bu'Lock FA. Response to letter. Br Heart J 1994;72:301.[Free Full Text]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert H. Anderson Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anderson, R. H. Search for Related Content PubMed PubMed Citation Articles by Anderson, R. H.