Unexpected persistence intoadulthood oflow wallstress inpatients withcongenital aortic stenosis: Isthere a fundamental difference inthe

Congenital aortic stenosis inchildren ischaracterized bylowleft ventricular systolic wallstress allowing forsupernormal ejection performance. Incontrast, adults withacquired aortic stenosis havenormal orexcessive systolic wall stress resulting ineither normal orsubnormal ejection performance. Inthis study young children withcongenital aortic stenosis, older children andadults withcongenital aortic stenosis, andadults withacquired aortic stenosis were evaluated totestthe hypothesis thatthechildhood pattern oflowwallstress wouldconverttotheadult pattern with advancing age.Leftventricular endsystolic wall stress was lower inbothcongenital aortic stenosis groupswhencompared withthatinage-matched normal subjects or adults withacquired aortic stenosis. Ejection fraction was higher inboth groupsofpatients withcongenital aortic stenosis thanin age-matched controls. There was notendency inthe16patients withcongenital aortic stenosis, some of whomwere followed totheage of33,forthecongenital pattern ofwallstress andventricular performance toconvert totheadult pattern. These results suggest that there isafundamental difference inthehypertrophic responsetoapressureoverload present atbirth compared withthe responsetoone acquired later inlife. Circulation 75,No.5,973-979, 1987. CHILDRENWITHcongenital aortic stenosis haveab- normal left ventricular systolic wallstress resulting in supernormal ejection performance. ".2 Adults withac- quired aortic stenosis havenormal orsubnormal ejec- tion performance.3-' We hypothesized that ifpatients withcongenital aortic stenosis werepermitted toma- ture into adulthood without relief ofthestenosis, the adult pattern ofstress andejection performance would develop. Therefore, weanalyzed ventricular perform- anceandcardiac mechanics inthree groups ofpatients withaortic stenosis: youngchildren withcongenital aortic stenosis, older children andadults withcongeni- talaortic stenosis, andadults withacquired aortic ste-