Aortic Valvotomy : These days aortic valvotomy even in neonates and critically ill infants is done under cardio pulmonary bypass. Through a median stemotomy, ascending aorta and right atrium are cannulated after heparinisation. On bypass aorta is clamped. Cold cardioplegia is administered into the aortic root. If necessary, retrograde cardioplegia is administered through coronary sinus. Transverse aortotomy is done. Aortic wall is retracted, valve inspected and itortic valvotoiny is done. The fused commissures are divided upto lrnm away from the junction of aorlic annulus.
Division of unicomrnissural valve and of a rudimentary raphe will produce severe incompetence and so should be avoided, occasionally myxornatous nodules could be removed without dainaging the cusps. Aortolomy is then closed with continuous prolene sutures. It is good to monitor LA and PA pressures a1d measure aortic gradient and LV and RV pressures before closing the chest.