Congenital Aortic Valvular Stenosis

The frequency with which the diagnosis of aortic stenosis is missed has been increasingly realized during the last 25 years. When a rough systolic is heard at the base of the heart a special effort should be made to feel a thrill, and if these two signs are present the diagnosis of aortic stenosis must be considered. The presence or absence of peripheral signs in the pulse is merely a measure of the severity of the stenosis; this principle is more widely recognized when there is an aortic diastolic murmur and aortic regurgitation, and may or may not be a water-hammer pulse and a wide pulse pressure. Btiologically, there is an even greater neglect of a possible congenital origin. We think that congenital aortic stenosis is relatively common but is often missed because so many years may pass before there are significant symptoms, and in a patient of forty or so, the lesion is looked on as calcific or atheromatous when these changes are simple additions to the congenital lesion. This assessment is of more than academic interest, bearing both on prognosis and the consideration of surgical relief. In this paper we wish to describe 40 cases of aortic stenosis that are, we think, congenital. About half of these were sent up ostensibly as congenital heart disease for a more detailed diagnosis, but