Faculty Collaboration Database

Aortoventriculoplasty in infants and children. Circulation 1992 Nov;86(5 Suppl):II176-80

Date

11/01/1992

Pubmed ID

1423996

Scopus ID

2-s2.0-0026470017 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

BACKGROUND: When aortic valve replacement is required in infants or small children with complex left ventricular outflow tract obstruction (LVOTO) or aortic incompetence (AI), the diameter of the annulus may limit the size of the prosthesis that can be safely inserted, and aortoventriculoplasty (AVP) may be required. To assess the results of this procedure in the pediatric age group, we reviewed our results in 19 patients who underwent AVP from May 1986 to April 1991.

METHODS AND RESULTS: Patient age ranged from 1 day to 18 years (mean, 5.9 years), with six patients < 2 years of age and 13 patients younger than 5 years. Operative indications included complex LVOTO after aortic valvotomy and/or subaortic resection (six), severe AI after valvotomy or aortic valve replacement (four), severe AI with bacterial endocarditis (one), truncus arteriosus with truncal insufficiency (three), failure of an apical-aortic conduit (three), and combined aortic stenosis and mitral stenosis (two). In all patients, valve insertion was performed after patch enlargement of the annulus and septum. Associated procedures included coronary artery reimplantation in five patients and mitral valve replacement in two. Mechanical valve prostheses were used in 15 patients and allografts in four. There were three hospital deaths (16%; 70% confidence limit, 9-26%), two in patients with severe pulmonary vascular disease, and no late deaths. Actuarial survival was 84 +/- 8% at 1 month and beyond (mean follow-up, 2.5 years). Complications have included complete heart block (one), residual ventricular septal defect (one), and early postoperative peripheral embolus (one). No late thromboembolic events have occurred. No patient has clinical or echocardiographic evidence of significant residual LVOTO or AI.

CONCLUSIONS: These data indicate that AVP may be performed at low risk and that it is an effective procedure for complex LVOTO or AI in infants and small children.

Author List

Frommelt PC, Lupinetti FM, Bove EL

Author

Peter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Actuarial Analysis
Adolescent
Aortic Valve
Aortic Valve Insufficiency
Child
Child, Preschool
Female
Follow-Up Studies
Heart Valve Prosthesis
Heart Ventricles
Humans
Infant
Infant, Newborn
Male
Risk Factors
Time Factors
Ventricular Outflow Obstruction