THE OPERATIVE APPROACH TO CONGENITAL AORTIC STENOSIS IN CHILDHOOD.

Forty-seven infants and children, aged from one month to 15 years, were operated upon during the past six years at the Hospital for Sick Children, Toronto, using extracorporeal circulation. Retrograde cardiac catheterization of the left ventricle with a pull-through tracing across the valve is important in selection of candidates for operation. Patients with a pressure gradient of over 45 mm. Hg require operation. In this series, valvular stenosis was the condition most commonly encountered; subvalvular membranous stenosis was present in eight patients, and muscular subvalvular stenosis in four. There was one operative death in an infant with multiple anomalies, and one late death from subacute bacterial endocarditis two years after operation. It is suggested that early operative treatment in cases of aortic stenosis in infancy and childhood might lessen the incidence of calcific aortic stenosis in adult life.