Aortic Valve Repair in Neonates

Abstract

Congenital aortic stenosis ranges from newborns with critical obstruction at valvar level and shock to less symptomatic neonates with gradual development of symptoms of heart failure. A team-based approach may provide the best results. Echocardiography gives essential information about the aortic valve, left-sided heart structures and associated lesions. Decision making between biventricular repair and single ventricle palliation is complex. In the case of borderline left ventricular size and function the hybrid procedure should be considered, allowing patients to recover and "declare themselves" as 1- or 2-ventricle candidates. Treatment strategies should prioritize quality of life and preservation of left ventricular function. Minimizing reintervention is an important secondary priority. Both balloon and open interventions are established and effective treatments for neonates. Reintervention rates depend on original morphology of the valve and method used. In comparison with blind ballooning, where the balloon can only tear the valve tissue, open valvuloplasty is done under direct vision and is individually tailored according to the anatomy, addressing not only commissural fusion but mixoid thickening of the cusps as well, can produce a better valve with a maximum valve orifice, without causing regurgitation. Such repair preserving function of the native valve without using artificial material allows for growth of the child, minimizing the need for intervention with excellent outcome if tricuspid geometry could be achieved.