Surgical approaches to critical aortic stenosis with unicommissural valve in neonates

Abstract

Critical aortic stenosis with unicommissural valve in the neonate is a complex lesion. These neonates have varying degrees of development of left-sided structures of the heart. Treatment decision depends on the anatomic and functional nature of the aortic valve and other left-sided structures. This review presents the various treatment modalities available for the treatment of these complex patients.

Keywords::

• congenital heart disease
• critical aortic stenosis
• neonate
• unicommissural aortic valve

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Postnatal imaging with echocardiography to determine the size and function of the left-sided heart structures is essential.

• Understanding the precise anatomy of the dysplastic aortic valve to determine if the neonate would benefit from balloon versus surgical valvotomy.

• Careful monitoring of the valvar function to determine if additional interventions are needed.

• As surgical valvotomy is more widely adapted, the long-term outcomes of this contemporary technique need to be documented.

• Some neonates may require initial routing down the single-ventricle pathway to achieve a biventricular circulation later in life.

Notes