SURGERY FOR VALVAR AND SUPRAVALVAR AORTIC-STENOSIS

Valvar aortic stenosis is the most common cause of congenital left ventricular outflow tract obstruction. Patients may present as neonates with congestive heart failue from critical aortic stenosis or as children with minimal symptoms or an asymptomatic murmur. Surgical repair is indicated for severe symptoms and for transvalvar pressure gradients >50 mm Hg. Open surgical valvotomy is the procedure of choice, although repeat valvotomy or valve replacement may be required subsequently. Supravalvar aortic stenosis is an unusual form of left ventricular outflow tract obstruction with focal or diffuse narrowing of the aorta above the sinuses of Valsalva. Indications for surgery are the same as for valvar aortic stenosis, and the techniques of aortoplasty are described.