Valve repair and replacement in children.

Therapy for valvular heart disease in children has undergone tremendous progress over the past two decades. Interventional catheterization techniques were pioneered with balloon valvuloplasty of pulmonic stenosis in infants. Therapeutic catheterization is the treatment of choice in critical pulmonic stenosis but remains somewhat controversial for neonatal aortic stenosis. The use of cryopreserved homografts has improved reconstruction of the right ventricular outflow tract. The pulmonary autograft (Ross) technique for aortic valve replacement has now been applied in neonates, infants, and small children. Medium-term results of this technique are now becoming available. Innovations have been few, however, in the therapy of tricuspid valve anomalies, especially Ebstein's malformation. Annuloplasty and repair techniques are used very effectively for mitral insufficiency, whereas congenital mitral stenosis remains extremely problematic in the younger child.