There has never been an ideal valve replacement for pediatric aortic valve disease. The concept of ideal valve surgery is to create a valve structure that is hemodynamically ideal, resistant to infection, anticoagulated, and able to maintain continuous growth, a requirement that neither biological nor mechanical valves can achieve [1]. In recent years, an increasing number of valvuloplasty procedures have been performed to suit different types of valve case changes, and the success of aortic valvuloplasty (AoVP) is particularly important in small infants and children who cannot undergo valve replacement. We use a modified technique of valvuloplasty for pediatric aortic valve disease in order to avoid or prolong the time to valve replacement in the long term This article retrospectively summarizes the postoperative outcomes. Data and methods From January 2002 to August 2010, 63 cases of pediatric aortic stenosis (AS) undergoing valvuloplasty were admitted to our institution, and aortic valvuloplasty was done, and the general data are shown in Table 1, which excludes patients with ventricular septal defect combined with aortic regurgitation and valve replacement. Patient details are shown in Table 1. The diagnosis of aortic stenosis was mild (transvalvular pressure difference <40 mmhg< span="">); moderate (transvalvular pressure difference between 41 and 75 mmHg); severe (transvalvular pressure difference >75 mmHg),preoperative echocardiography aortic annulus and left ventricular outflow tract size without significant obstruction, and the diagnosis of aortic regurgitation (AI) [2] was 1. mild (no dilatation of the left ventricular outflow tract and no retrograde flow in the descending aorta); moderate (left ventricular end-diastolic volume size Z value in the range of 2 to 4 and retrograde flow in the descending aorta); and severe (left ventricular end-diastolic volume size Z value in the range of >4 and retrograde flow in the descending aorta), with all data converted by body surface area to obtain a Z value. The preoperative echocardiographic diagnosis was mainly AS in 16 cases, mainly AI in 19 cases, and both in 28 cases; the estimated left heart insufficiency was also divided into mild, moderate and severe. Surgical methods: The surgery was performed under shallow medium to low temperature extracorporeal circulation, with the aortic cannula inserted as far as possible in the distal part of the ascending aorta near the innominate artery, with a Hocky incision in the ascending aorta, and the aortic valve leaflets were examined for diastolic, triastolic, and quadruastolic valves; 36 cases had two-valve aortic malformations (57.1%), 26 cases had triastolic malformations (41.3%), and 1 case had a quadruastolic aortic valve (1.6%). The different methods of valvuloplasty are shown in Table II, with leaflet junction suspension being the most frequent. The vast majority of patients require a combination of techniques, such as valvular junctional dissection most commonly used to eliminate leaflet stenosis, but often accompanied by the application of regurgitation prevention techniques such as excision of redundant margins, leaflet junctional suspension, and lengthening of leaflet margins to examine the length, extent, and irregular shape of the free margins, using their own pericardial slices (0.6% glutaraldehyde fixed for 3 minutes and then fixed by saline immersion) The free edge of the dissected aortic leaflet was lengthened in 12 cases for cusp extension, which was used in patients with two to three valves (see Figures 1 to 3). Results Clinical and ultrasound follow-up of all patients ranged from 3 months to 3 years, with 2 early deaths and no deaths during follow-up, early postoperative ventilator-assisted time of 8 to 79 hours, and postoperative left atrial pressure of 1.2 to 1.8 Kpa (mean 1.5±0.5). The duration of ICU stay ranged from 3 to 6 days (mean 4.5±1 days), and the length of hospital stay ranged from 6 to 18 days (mean 8.5±2 days). No thrombosis or valve infection occurred, and no anticoagulation was required. During the postoperative follow-up time, color photographs showed that 1. 2 of 17 cases of preoperative simple aortic stenosis had mild to moderate to severe aortic stenosis after surgery, one of which had a combined supravalvular stenosis and underwent valve replacement at the same time as reoperation, and the other case was still under follow-up, and only one case had moderate AI after surgery, while the rest had mild regurgitation; 2. None of the cases with preoperative simple AI had AS after surgery, however, one case had aggravated postoperative However, there was one case of postoperative aggravated AI, which was prepared for possible aortic valve replacement; 3. All but two cases with preoperative mixed aortic valve disease had satisfactory valves, one case with severe AI and combined endocarditis, which had been replaced, and another case with severe AS, which was being followed up. Discussion Although valve replacement surgery for aortic disease is common in adults and has many advantages, it is impossible to be completely suitable for pediatric aortic valves because of their special characteristics, therefore, plastic surgery of the aortic valve occupies an important place in the field of pediatric aortic valve disease [3]. Although the revision of their valves in infancy is challenging due to their age, immature and fragile leaflets, and concomitant malformations, we believe that revision surgery of the valves is required. The effect of aortic valvuloplasty is also to establish a not optimal but as satisfactory as possible aortic valve function, rather than to construct a normal aortic valve structure; or to delay or reduce the likelihood of subsequent valve replacement [4]. The key is the preoperative assessment of the structure of the valve malformation and the mechanisms leading to valve stenosis and regurgitation, as well as the postoperative hemodynamic stability. I. Hemodynamics after aortic valvuloplasty Valve replacement surgery may not achieve the desired hemodynamics in the pediatric population, and aortic valvuloplasty is sometimes the ideal corrective treatment, although the presence of differential pressure in the left ventricular outflow tract does not show any symptoms, especially for mechanical valves or even biological valve replacement, where a small differential pressure already has a potentially chronic damaging course for the left ventricle. The follow-up results in an increase in the thickness of the left ventricular biscuit [5], which is not the case with good valvuloplasty. In the vast majority of non-obstructed patients with good aortic valvuloplasty results, postoperative hemodynamic function can be significantly improved. AI caused by stenosis correction, for example, can be implemented by surgical lengthening of the aortic valve edge, which preserves the growth potential of the aortic valve and has greater hemodynamic advantages compared with the replacement of a small prosthetic valve. In this group, regardless of the preoperative type of aortic valvuloplasty, postoperative valve function is significantly improved, and if the contact surface of the adjacent valve is thickened, it can be replaced by its own tissue that can be kept thin intraoperatively, it is possible to reduce the occurrence of stenosis, and similarly AI patients who can increase the contact surface of their adjacent valves intraoperatively [6] can reduce or even not have postoperative AI. if the expected results are not achieved intraoperatively, then the use of aortic valve edge lengthening approach. Second, the application of aortic valve edge lengthening Ross procedure is a very useful technique in infantile aortoplasty, but it is difficult to have a growing Homogarft duct, which sometimes even causes dilatation of the aortic root, so another surgical approach needs to emerge that avoids these disadvantages, the latter having both good postoperative hemodynamics and its own anticoagulation. It can also be the ultimate method of valvuloplasty. The surgical method of aortic valve edge lengthening is suitable for [7] neonatal AS, simple cases of aortic valve fusion, and ventricular ischemia combined with AI, etc. This article focuses on valve edge lengthening, the key being that the pericardial slices are 10%-15% higher than the original height of the valve edge, while the width is 25% wider than the original, which allows the edges of the three valves to meet higher at the midpoint, or even at the level of the same height as the valve junction, increasing the leaflet contact area and reducing valve regurgitation. This increases the contact area of the valve leaflets and reduces regurgitation of the valve. The suture is 5-0 prolene continuous, with a slightly wider stitch distance on the pericardial slices than on the flap margins, in a radial pattern, and generally with the flap junction point slightly above the leaflet midpoint. The combination of suspension fixation of the valve junction should be appropriate to avoid excessive tissue hindering the opening and closing of the valve. Aortic valvuloplasty should be performed except for combined left ventricular outflow tract obstruction, otherwise Ross-Konno procedure should be performed [8]. Third, the prognosis of aortic valvuloplasty Ross surgery or plus Konno surgery increases the surgical approach to aortic valvuloplasty in infants and children, but requires the addition of another Homograft conduit, which also increases the number of reoperations and results in the distant future, and is likely to cause restenosis problems in both valves, so there is a need to find a surgical treatment that avoids the disadvantages of both and has the potential to allow the valve to have natural growth functional surgical treatment [9]. We consider aortic annulus that is not small, simple AS or aortic valve with severe regurgitation and without obstruction of the left ventricular outflow tract can undergo valvuloplasty. This is evaluated preoperatively for annular size, and we can change the single valve to two valves and two valves to three valves, which can minimize postoperative AS. In subsequent follow-up, the reoccurrence of AS after triple valve surgery is much lower than in those with two valves, and in those with pure valve regurgitation we do not use a pericardium intraoperatively to avoid postoperative AS, but those with AS combined with AI use a pericardium to extend the margins of the valve leaflets, which can effectively reduce postoperative AI. However, there can be a postoperative pressure difference of 20-25 mmHg, which is similar to that reported in the literature [10]. In our group, we reported 2 deaths, both of which occurred in those with AS or combined AI, and a higher rate of distant reoperation in the latter has been reported in the foreign literature, and our report is similar. In valvular junctional dissection unless the valve is well developed, thin, flexible, and mobile, the edges of the valve are extended with a fixed pericardium to increase the degree of valve alignment and mobility. There was only one case of exacerbation during the follow-up, and it was a combination of both AS and AI, with the possibility of pericardial calcification reported in the literature, and our group may need to be followed up for a longer period of time before results can be obtained. In patients with AI alone, we did not use pericardium to reduce postoperative valve stenosis, but in patients with both AS and AI there is always a need to use pericardium to lengthen the valve and to prevent the increase of regurgitation of the valve. results, because only then can the aortic valve best withstand the pressure capacity of the aortic valve and achieve the most desirable long-term hemodynamic results [11]. For mixed aortic valve disease the long-term results in follow-up are significantly worse than for simplex, so if reoperation is performed, valve replacement is performed if possible. In conclusion, for pediatric aortic valve revascularization, especially valve edge lengthening, is a practical approach to prolong and reduce the time for subsequent valve replacement, and early revascularization is effective, especially in patients with AI combined with AS, where early revascularization is still possible, reoperation rates are relatively low, and early intervention can reduce valve damage. However, if aortic regurgitation is combined with a small annulus, the surgical difficulty increases.