The surgery of aortic valve disease in neonates, infants and children.

The pre-operative findings and surgical results of forty-three patients under thirteen years of age undergoing isolated aortic valve surgery are reported. Twenty-six underwent open aortic valvotomy for isolated aortic valve stenosis. Of the nine who died, five were neonates. These deaths are attributed to an underdeveloped myxoid valve and aortic valve ring. Eleven children underwent excision of the subvalvar diaphragm but four developed asymptomatic left ventricular strain on ECG and required re-operation. There was one death. One child underwent successful surgery for supravalvar stenosis. Five children underwent surgery for isolated aortic regurgitation. Two underwent repair, but one required aortic valve replacement for uncontrolled regurgitation. Three had aortic valve replacement as a primary procedure. The management of left ventricular outflow tract obstruction and the choice of replacement valve is discussed.