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Chapter 15 - Aortic Stenosis

from Section 3 - Left-Sided Obstructive Lesions

Published online by Cambridge University Press:  09 September 2021

Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

Aortic stenosis occurs in almost 5% of patients with congenital heart disease. Valvular aortic stenosis results from narrowing of the orifice size due to aberrant valve leaflets and is frequently associated with other cardiac lesions. Echocardiography is used to diagnose and quantify the degree of aortic stenosis. Neonates with critical aortic stenosis can present in congestive heart failure requiring urgent intervention, often a percutaneous balloon valvuloplasty. Infants, children, and adults are often asymptomatic, even in the setting of severe aortic stenosis. Surgical interventions for aortic stenosis include aortic valve repair, aortic valve replacement with a pulmonary autograft, or replacement with a mechanical valve. The Ross procedure describes using a pulmonary autograft in the left ventricular outflow tract and pulmonary homograft in the right ventricular outflow tract while the Konno procedure widens a stenotic left ventricular outflow tract. Aortic regurgitation and, less commonly, pulmonary homograft dysfunction can be seen after the Ross procedure.

Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
, pp. 90 - 96
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Singh, G. K.. Congenital aortic valve stenosis. Children 2019; 6: 112.CrossRefGoogle ScholarPubMed
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Nelson, J. S., Pasquali, S. K., Pratt, C. N., et al. Long-term survival and reintervention after the Ross procedure across the pediatric age spectrum. Ann Thorac Surg 2015; 99: 2086–95.CrossRefGoogle ScholarPubMed

Suggested Reading

Gottlieb, E. A. and Andropoulos, D. B. Anesthesia for the patient with congenital heart disease presenting for noncardiac surgery. Curr Opin Anesthesiol 2013; 26: 318–26.CrossRefGoogle ScholarPubMed
Mavroudis, C., Mavroudis, C. D., and Jacobs, J. P. The Ross, Konno, and Ross-Konno operations for congenital left ventricular outflow tract abnormalities. Cardiol Young 2014; 24: 1121–33.Google ScholarPubMed
Stulak, J. M., Burkhart, H. M., Sundt, T. M., et al. Spectrum and outcome of reoperations after the Ross procedure. Circulation 2010; 122: 1153–58.CrossRefGoogle ScholarPubMed

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