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Natural hemodynamic history of congenital aortic stenosis in childhood

1972; Elsevier BV; Volume: 30; Issue: 1 Linguagem: Inglês

10.1016/0002-9149(72)90117-8

1879-1913

Galal M. El-Said, Frank M. Galioto, Charles E. Mullins, Dan G. McNamara,

Congenital Heart Disease Studies

The natural hemodynamic history of 37 patients with congenital aortic stenosis (18 valvular, 10 valvular with slight or moderate aortic insufficiency, 6 discrete subvalvular and 3 supravalvular) was documented by 2 catheterizations using the same methods of study. In the majority of patients with valvular, discrete subvalvular and supravalvular aortic stenosis the anomaly increased in severity, as evidenced by (1) a statistically significant increase in left ventricular peak systolic pressure, left ventricular to aortic peak systolic pressure gradient and arteriovenous oxygen difference; and (2) by a significant decrease in cardiac index and stenotic orifice area per square meter body surface area. The changes were more severe in patients with supra- and subvalvular stenosis. There were no statistically significant changes in aortic pressure, heart rate, systolic ejection period or wedge pressure. Left ventricular end-diastolic pressure increased significantly only in patients with discrete subvalvular aortic stenosis. Although the stenotic area index was lower in all patients without aortic insufficiency, absolute stenotic area decreased in only a small percentage. In patients with both valvular aortic stenosis and insufficiency, there was a significant unfavorable change in cardiac index, arteriovenous oxygen difference and left ventricular end-diastolic pressure but no significant increase in left ventricular peak systolic pressure or left ventricular to aortic peak systolic pressure gradient. Ninety percent of the patients remained asymptomatic during the study. Aortic stenosis is likely to increase in severity, usually by an increase in flow across a "fixed" stenotic area as a result of body growth and sometimes by a concomitant actual decrease in stenotic area.