Aortic Valve Surgery in the Pediatric Population

Abstract

In this paper, current approaches to pediatric aortic valve surgery are discussed. While many pediatric aortic valve operations are palliative until an adult-sized prosthetic can fit, some recent advances in adult aortic valve repair techniques can be applied to the pediatric population yielding more definitive repair. Systematic analysis of the valve pathology is necessary to decide on the appropriate operation and refer patients to surgeons with the appropriate expertise. The Ross operation remains an ideal operation for pediatric patients with significant aortic valve disease and a competent pulmonic valve, given that it allows the autograft to grow with the child. Depending on aortic valve pathology, those with regurgitation secondary to aneurysmal dilation of the aorta may be candidates for various valve-sparing techniques. Critical congenital aortic stenosis may be managed via balloon valvuloplasty or surgical valvotomy depending on the specific scenario. Valve replacement is not ideal in the pediatric population, particularly if the patient is not full-grown, but can be necessary.