ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2019, 4(6): 142–149
https://doi.org/10.26693/jmbs04.06.142
Clinical Medicine

Treatment of Infants with Critical Aortic Stenosis

Imanov E. 1, Truba Y. P. 1, Plyska O. I. 2, Grusha M. M. 3, Lazoryshynets V. V. 1
Abstract

Aortic stenosis (narrowing of the aorta due to a decrease in the area of the aorta mouth) is a group of congenital heart disease caused by impaired blood flow from the left ventricle. Critical aortic stenosis is a complicated pathology in infants, which requires ergent help. Treanment of such patients is a complex and difficult problem. Surgical methods of treatment include ballon alvuloplasty and open surgical valvuloplasty. The purpose of our work was to analyze personal experience of surgical treatment and ballon alvuloplasty in infants with critical aortic stenosis. Material and methods. 58 patients with critical aortic stenosis were treated in National Amosov Institute of Cardiovascular Surgery during 2007-2018. Results and discussion. In the 1st group hospital mortality made up 6.8 % (n=4). In the 2nd group 4.5 % of patients in postoperative period had complicated two-side pneumonia, sepsis, and patients died on the 15th and 20th days after procedure from increased respiratory and multiorgan failure. After ballon valvuloplasty we noted significant decrease of gradient on aortic valvule in patients of the 1st group and increased ejection fraction of left ventricule. But at mid-distance monitoring there increased gradient of pressure on aortic valvule in most patients and aortic failure began. There were no lethal cases in the 2nd group. The time of artificial circulation of lungs on average after dilatation made up 31±12 hours (from 5 to 298 hours) in the 1st group, and 38±16 hours (from 8 to 330 hours) (Р<0.05) in the 2nd group. The time of staying in ranimation made up 3 days (from 2 to 40 days) in the 1st group, and 5 days (from 3 to 60 days) (p<0.05) in the 2ndgroup. According to the Echocardiography, which was performed regularly within 24 hours after surgery, a significant decrease in the gradient was observed both in the 1st group from 65.2±2.7 to 30.3±3 mm Hg (p <0.05) and in the 2nd group from 79.1±5.5 to 32.73±3.18 mm Hg (p <0.05). Significant increase in the ejection fraction of left ventricle was observed in patients of the 1st group who had ejection fraction of left ventricle 48.21±3.1% (from 18 to 75 %) at admission and 60.2±1.67% (from 55 up to 75%) at discharge. In the 2nd group patients ejection fraction of left ventricle did not significantly change and was 65.82±4.33% (from 59 to 75%) before surgery, and 67.82±2.9% (from 65 to 85%) at the time of discharge. The period of staying in hospital of the 1st group patients made up 7.7±1.0 days, and the 2nd group patients were 15.9±1.9 days in hospital (Р<0.01). Such a difference was due to smaller traumatic this surgical procedure in the 1st group. Conclusion. Both surgical valvuloplasty and balloon valvuloplasty are effective methods of aortic stenosis treatment in infants with good results. The obtained results showed that balloon valvuloplasty can be acceptable alternative to surgical treatment in patients with expressed cardiac failure. But it has tendency to increases of aortic failure in remote period. The length of patients staying in hospital after balloon valvuloplasty is half shorter that patients with balloon valvuloplasty, which significantly reduces the expenses on treatment.

Keywords: сritical aortic stenosis, surgical aortic valvuloplasty, ballon valvuloplasty, infants

Full text: PDF (Ukr) 231K

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