Aortic valvulotomy in neonates.

Fourteen consecutive newborns, 1 month of age or younger (mean age 12 days; mean weight 3.5 kg), had aortic valvulotomy for critical life-threatening aortic stenosis.Seven infants died early and seven survived hospitalization.Clinical, laboratory, catheterization, operative and autopsy data were analyzed to determine factors relevant to success or failure.Left ventricular chamber size and operability of the aortic valve and annulus were the most important deter- minants of outcome.All nonsurvivors except one had small left ventricles.All survivors had normal-sized ven- tricles and aortic annuli >5 mm.Left ventricular end-diastolic volumes (LVEDV) were calculated from cineangiograms in 10 infants.Six survivors and one nonsurvivor, who developed ventricular fibrillation before bypass, had LVEDV >35 ml/m'.Three nonsurvivors had LVEDV < 30 ml/m2.Poor peripheral perfusion, severe acidosis (pH < 7.25) and right ventricular hypertension (> 60 torr) were significantly more common in nonsurvivors than in survivors.Seven nonsurvivors and only one survivor either required immediate operation or developed ventricular fibrillation during operation before bypass.Two subgroups of newborns with isolated aortic stenosis are identified.Those with small left ventricular chambers represent an intermediate group between patients with "hypoplastic left-heart syndrome" and nor- mals.Aortic valvulotomy did not save these infants.In contrast, seven of eight newborns with normal-sized left ventricles survived valvulotomy and six remain alive 1.5-6.5 years after operation.NEWBORNS with symptomatic aortic stenosis re- quire urgent or emergency valvulotomy, and mortality is higher than in older infants and children.1-7 Between 1973-1978, 36 children and infants older than 1 month 'have had operation at Children's Hospital of Phil- adelphia for valvar, supravalvar and subvalvar aortic stenosis, and all survived.Others also have reported low mortality.46 However, in newborns 1 month of age or younger, mortality was 29% and 71% in two series of seven patients each.8' 9This study was undertaken to determine factors that affect survival after aortic valvulotomy in newborns.November 1970 and October 1977, 14 newborns up to 1 month of age had aortic valvulotomy consecutively by one surgeon.Five infants were operated at the Moffitt Hospital, San Francisco Methods Between