Severe aortic valve diseases and aortic isthmus stenosis in adults. Incidence, clinical aspects and long-term results of surgical treatment

• Published in: Zeitschrift für Kardiologie 1997-09, Vol.86 (9), p.676-683
• Main Authors: Turina, J, Hippenmeyer-Zingg, I, Schönbeck, M, Turina, M
• Format: Article
• Language: ger
• Subjects: Adolescent; Adult; Aortic Coarctation - diagnosis; Aortic Coarctation - mortality; Aortic Coarctation - physiopathology; Aortic Coarctation - surgery; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Bioprosthesis; Child; Female; Follow-Up Studies; Heart Valve Prosthesis; Hemodynamics - physiology; Humans; Male; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Reoperation; Survival Rate; Ventricular Function, Left - physiology
• ISSN: 0300-5860

Severe aortic valve disease is a rare complication of coarctation in adults. Between 1961 and 1990 aortic valve replacement was performed after or combined with the operation of coarctation in 24 adults (4% of entire population operated for coarctation). Bicuspid aortic valves were present in 2/3 of patients. In 10 patients (7/10 with aortic stenosis) coarctation was operated early (mean age 24 years) and aortic valve late (mean age 40 years): in 14 (10/14 with aortic regurgitation, mean age 40 years) aortic valve and coarctation were operated simultaneously (8 patients) or staged within 6 months (6 patients). Additional surgical interventions on the dilated aorta ascendens were performed in 8, mitral valve replacement in 2 and aorto-coronary bypass in 1 patients. Early mortality was 2/24 (8%) and was similar in simultaneously (1/8) and staged (1/14) operated cases: 10 year survival was lower than in an age-matched group of 72 patients with aortic valve disease of similar severity operated during the same period (70% vs 88%, p < 0.01): 6/7 late deaths were cardiac; 5/5 pts with preoperatively severely increased end-diastolic (> 199 ml/m2) and 4/4 with end-systolic (> 90 ml/m2) left ventricular volumes and 2/2 with ejection fraction < 41% died late postoperatively. Severe aortic valve disease arised in 4% of adults with coarctation or after coarctation resection. The results of valve replacement in these patients were less successful due to high late mortality in cases with severe preoperative left ventricular dilatation and/or decrease of ejection fraction. Thus, close surveillance of patients after coarctation surgery, especially those with bicuspid valves, is mandatory for early detection of valvular disease and appropriate timing of valve replacement before left ventricular function begins to deteriorate.