(Objective):Optimal management for critical aortic stenosis(AS) in neonates and early infants remains a challenge to cardiologists and cardiac surgeons. In our institution, surgical valvotomy is the first-line treatment for critical AS, although balloon valvuloplasty has become most popular treatment in elsewhere.

(Methods):A retrospective review of neonates and small infants undergoing surgical valvotomy in single institution between 1993 and 2007 was carried out. Clinical and echocardiographic follow up data were analyzed. Twelve infants less than 6 months (mean age:47 days) underwent surgical valvotomy for critical AS. Mean body weight at surgery was 4.2kg(range:2.6 - 6.5kg). Surgery included aortic commissurotomy and excision of myxomatous valve tissue. One patient who underwent balloon valvuloplasty at other institution was referred to us for severe aortic regurgitation(AR). .

(Results):There were no mortality with a mean follow up of 73 months.There were 4 reoperations including 2 re-valvotomy and 2 Ross in 3 patients. All 3 patients had unicusp or bicusp. One patient who underwent balloon valvuloplasty elsewhere after surgical valvotomy, had developed severe AR and required Ross procedure . Another patient required re-valvotomy at 15 months after and required Ross . Most recent echocardiogram showed less than Grade 1 AR in 10 patients and Grade 2 in 2. No patient has developed significant re-AS. Freedom from re-intervention at 4 years was 75%. Freedom from AVR or Ross was 83%.
(Conclusions):Surgical valvotomy and excision of myxomatous tissue for critical AS results in a low early and late mortality, a low recurrence of significant AR and AS.