Effect of ventriculoseptal myectomy on surgical management of subaortic stenosis

In this study 29 cases of subaortic stenosis were analyzed to evaluate the value of septal myectomy in surgical management of subaortic stenosis. They were classified into 2 groups: Group I included 16 cases without myectomy and group II 13 cases for whom myectomy [in 10 cases] or myotomy [in 3 cases] was performed with excision of subaortic membrane of fibromuscular ridge. Immediate and late postoperative pressure gradient measurements across LVOT, showed smaller gradient in group II. There was more regression of the gradient during follow up visits in patients, for whom septal myectomy or myotomy was performed. Septal myectomy is recommended in cases of subaortic stenosis. The amount of resection is adjusted according to the degree of septal hypertrophy

Surgical evidence for the mechanism of spontaneous closure of VSD, and its implications on management of closing defects

This study had been conducted on 140 patients of ventricular septal defect. They were divided into two groups. Group I, 25 patients with surgical evidence of partial spontaneous closure of VSD. Group II, 115 patients without attempts of spontaneous closure of the defect. The clinical symptoms and signs of cardiomegally, lung congestion and pulmonary hypertension were more apparent in group II. Radiologic electrocardiographic and echocardiographic evidences of large VSD, left to right shunt, ventricular enlargement and pulmonary hypertension were also more evident in group II. The best technique for surgical closure of such closing defect was found to be patch closure by either the remaining defect in tricuspid tissue or the original VSD after incising the septal leaflet of tricuspid valve, with continuous sutures in the fibrous tissue formed around the defect. This method is devoid of conduction defect or residual shunt