THE UNNATURAL HISTORY OF AORTIC STENOSIS

Abstract

We report on the clinical course and serial hemodynamic studies of three patients with severe valvar aortic stenosis diagnosed in the neonatal period. None of the subjects was symptomatic in the first year of life. In each case, a conservative initial management approach was adopted. Between the time of initial study (mean age 1.8 months) and the follow up at 12-27 months of age (mean 14.3 months), mean left ventricular systolic pressure fell from 151 to 135 mmHg, the mean peak systolic pressure gradient across the aortic valve fell from 54 to 42 mraHg, and the mean calculated aortic valve area index increased from 0.20 to 0.39 cm2/meter2. One of the patients was operated on for symptoms which appeared at 14 months of age. The patient followed longest is now 5 years old, is growing well, has a normal electrocardiogram and an echo-predicted left ventricular systolic pressure of 128 mmHg. This experience suggests that not all asymptomatic neonates with severe valvar aortic stenosis require surgical intervention early in life. In some, the aortic valve orifice may increase in size with somatic growth and obviate the need for surgery in early childhood.