Abstract
In order to study morphology and prognosis of congenital aortic stenosis, twelve surgical patients aged from 6 to 54 years were reviewed. All patients had the bicuspidal aortic valves. The bicuspidal valves were classified into two types according to the morphological features-symmetric type and asymmetric type. We defined "symmetric type" as that two commissures divide the inner circumference of the valvular ring into equal length and that the two cusps are nearly same size. All other cases were classified as "asymmetric type". Three out of six children showed symmetric type, and other three asymmetric type. Three adults showed symmetric, two asymmetric and one was indeterminable because apico-aortic bypass operation was done in which the aortic valve was not inspected. All six children in both types underwent valvotomy, in which the two commissures were incised to enlarge the valve orifice. All the cases of symmetric type had good post-operative course for 11 to 15 years after the valvotomy. Asymmetric type cases had less satisfactory post-operative course with a tendency of residual stenosis or restenosis. As most of the adult cases had the calcified aortic valves which were replaced by the prosthetic valves and the long-term prognosis of valvotomy was well in symmetric aortic stenosis, we suggest that valvotomy of the bicuspid valves should be performed in the early stage. However, in asymmetric type of aortic stenosis, a new device of valvotomy should be considered.
