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138 CHANGING PATTERNS IN MANAGEMENT OF AORTIC VALVAR STENOSIS IN INFANCY

In the past, management of infants with critical isolated aortic (AO) valve (V) stenosis (AVS) was dependent on diagnosis by cardiac catheterization (cath). In critically ill infants this procedure is often associated with severe complications. As of 1981, 10 infants, ages 1 day to 18 weeks, were diagnosed as having critical AVS. Anatomic diagnosis was made by 2D Echo-cardiogram (Echo) in all patients (pts) showing a thickened AOV (10/10 pts) left ventricular hypertrophy (LVH) (10/10 pts), normal LV size (8/10 pts) LV dilatation and small LV (1 pt each). Left atrial dilatation, indirectly indicating increased LV end diastolic pressure, was present in 9/10 pts. Diagnosis was confirmed by cath in 4 pts, surgery in 5 pts, and autopsy in 1 pt. Aortic valvotomy was done in 5 pts without cath and 4 pts following cath. Prior to surgery the pts had clinical evidence of poor cardiac output (10/10 pts), LVH (10/10 pts) and strain (8/10 pts) on ECG and cardiomegaly on chest x-ray (10/10 pts). A 1 day old infant in persistant acidosis with a dilated LV died prior to surgery and a pt with a small LV on echo died postoperatively. 8 pts survived surgery. It is concluded that noninvasive clinical evaluation is adequate for precise diagnosis and estimation of severity prior to aortic valvotomy in infants. Cath is presently of limited value in such patients and should be reserved for infants with AVS and possible associated defects.