Evaluation of early outcomes of valvular and subvalvular and supravalvular aortic stenosis surgery in children

Abstract

Aortic stenosis is a relatively common disorder that occurs in about 5% of children with heart disease and results from the abnormal development of the aortic valve or under the influence of several diseases. The causes of aortic valve disease vary in different communities and places. Left ventricular outflow stenosis due to aortic valve stenosis can occur in three different levels including valvular, supravalvular, and subvalvular. Annually 10-15 cases of aortic valve stenosis (valvular, supravalvular, and subvalvular) are operated in Shahid Madani Hospital in Tabriz. We have no information regarding the results of surgery in these patients and no similar study has been conducted in recent years in Iranian university hospitals. Thus, we aimed to conduct this study. Materials and Methods: In this cross-sectional study, all children aged 1 month to 20 years who were diagnosed with aortic valve stenosis (valvular, supravalvular, and subvalvular) and underwent open heart surgery in Shahid Madani Hospital in Tabriz from 2006 to 2018, were included in this study. Based on the information in the records of these patients, we recorded information about demographics (based on age, sex and weight), type of aortic stenosis, type of surgery and time of surgery as well as echocardiographic findings before and after the surgeries. Finally, based on this information we evaluated early outcomes of aortic stenosis surgery in children. Results: In this study 62 patients(73.8%) had left ventricular outflow stenosis at one level (45.23% valvular, 15,47% subvalvular, 13.09% supravalvular) and 22 patient (26.8%) had left ventricular outflow stenosis more than one level (15.47% valvular+ subvalvular , 7.14% valvular+ supravalvular , 3.57% valvular+ subvalvular+ supravalvular). In the study of severity of left ventricular outflow stenosis, 1.2% of the patients had mild, 16.6% moderate and 82.2% severe stenosis. Immediately after the surgery, 51.25% of patients had no stenosis, 40% had mild stenosis, 8.75% had moderate, and unfortunately 5% of them died. 6 months after the surgery, 50% of the patients had no stenosis (patients with stenosis in one level: more than 50% , patients with stenosis in more than one level:28.5%) , 28.75% had mild, 17.5% had moderate and 2.5% had severe stenosis in left ventricular outflow. After the surgery, in patients who underwent web resection+ myomectomy, more AI was seen and in patients who underwent commissurotomy, more AI and AS was seen. There was an inverse correlation between Bentall surgery and AI remaining. Statistical studies have shown that commissurotomy increased mortality rate in patients, which may be explained by the unstable hemodynamic conditions of the patients (3 patients were less than 6 months old and 1 patient was 1 year old). There is no significant correlation between mortality and subvalvular, valvular and supravalvular stenosis of the aorta. There is no significant relationship between CPB.time and subvalvular, valvular and supravalvular aortic stenosis.