ABSTRACT
PURPOSE: This study attempted to describe the Doppler and two-dimensional echocardiographic features of fixed subaortic stenosis, the de novo occurrence and progression of this lesion and to review its etiology, treatment and course. METHODS: We studied 17 patients of fixed subaortic stenosis who, between Jan. 1993 and Jan. 1996, ware diagnosed by echocardiographic examination at Kyungpook National University Hospital. The patients' charts, the Doppler and echocardiographic findings as well as the operative reports were retrospectively reviewed. RESULTS: 1) There were 17 patients (14 boys and 13 girls, male/female ratio 1:1) of fixed subaortic stenosis which comprised 1.1% of congenital heart disease (17/1609) and 15% of congenital left ventricular outflow tract (LVOT) obstruction (17/113). 2) Ages of first detection ranged from 3 days to 11 years (mean : 2.74 years), and most of them (14/17) were under 5 years, and 8 under 1. 3) All of them had other major cardiac diseases and subaortic stenosis was diagnosed incidentally during the evaluation (initial and follow-up) of major cardiac diseases. Mean duration between diagnosis of major cardiac diseases and that of subaortic stenosis (11 cases) was 2.83 years (4 months-10 9/12 years), and the other 6 cases were diagnosed coincidentally. 4) The types of fixed subaortic stenosis were membranous in 10 cases (58.8%) and fibromuscular in 7 cases (41.2%). 5) Mean left ventricular to aortic peak systolic pressure gradient (Doppler) at initial diagnosis (9 cases) was 26.6 mmHg and in 6 cases underwent surgical resection 29.17 mmHg but there were no gradient in 8 cases. 6) Aortic insufficiency was found in 4 cases (23.5 %). 7) There were some evidences of progression of the lesion in 4 patients inspite of relatively short follow-up period (mean : 2.08 years). 8) Resection of fixed subaortic stenosis (membranectomy) was performed in 6 cases. CONCLUSIONS: Our data that most cases were coexisting with congenital heart diseases, and under 5 years of age suggest subaortic stenosis is a congenital lesion but also does not rule out it is an acquired lesion in the presence of some evidences of progression in our four patients.
Subject(s)
Child , Female , Humans , Blood Pressure , Constriction, Pathologic , Diagnosis , Echocardiography , Follow-Up Studies , Heart Defects, Congenital , Heart Diseases , Retrospective StudiesABSTRACT
PURPOSE: To analyze, by cross-sectional echocardiography, morphological features of the atrial atrioventricular and ventricular septum potentially involved in the genesis of fixed subaortic stenosis. METHODS: Forty three children with fixed subaortic stenosis were compared with 86 normal children, matched by age, sex and body surface, and 43 children with congenital heart defects without fixed subaortic stenosis. RESULTS: The groups did not differ in as age, sex or body surface. The atrioventricular septum was significantly smaller in children with subaortic stenosis than in normal children or patients with other congenital heart diseases. The ventricular septum was significantly more aligned with the atrial septum in cases than in normal children and in patients with other congenital heart diseases. The odds ratio for the development of fixed subaortic stenosis was statistically significant in the presence of a short atrioventricular septum and with alignment of the ventricular and atrial septum, when analyzed in isolation or when controlled by perimembranous ventricular septal defect. CONCLUSION: It was concluded that in fixed subaortic stenosis the atrioventricular septum length is decreased and that this alteration may be a risk factor for its development
Objetivo - Estudar, através do ecocardiograma bidimensional, aspectos morfológicos dos septos atrial, atrioventricular e ventricular, potencialmente envolvidos na gênese da estenose subaórtica fixa. Métodos - Foram avaliadas 172 crianças divididas em três grupos: 43 casos com estenose subaórtica fixa, 86 controles normais e 43 controles cardiopatas. Foram estudadas a distância mitro-aórtica, a distância mitrotricuspídea e o índice de desalinhamento dos septos atriale ventricular. Resultados - Os grupos não diferiram quanto a idade, o sexo e a superfície corpórea. A média da distância mitro-aórtica mostrou-se aumentada no grupo de casos em relação aos controles. As médias da distância mitrotricuspídea e do índice de desalinhamento mostraram-se diminuídas no grupo de casos em comparação com os grupos controles. Houve correlação entre as variáveis, que mostraram razão de chances significativamente altas para o desenvolvimento da doença. Conclusão - Concluiu-se que, na estenose subaórtica fixa, a separação mitro-aórtica encontra-se aumentada e o septo atrioventricular diminuído e que estas alterações podem constituir risco para o seu desenvolvimento