Value of morrow procedure in surgery of discrete membranous subaortic stenosis

Subuortic stenosis constitutes up to 20% of all farms of left ventricular outflow had [LVOT] obstruction in children. Although the resulting significant left ventricular hypertrophy and aortic insufficiency are clear indications for surgery, controversy persists whether to remove the membrane in symptom-free patients with an isolated membrane or not. In addition to the timing of surgical repair, the surgical technique remains an area of discussion. In this study, we try to evaluate the impact of early surgical interference as well as surgical technique on the early and mid-term outcome. 44 patients with a mean age of 9.26 years [range, 2.4-28 years] underwent surgical resection for discrete membranous subaortic stenosis [DMSS]. For the purpose of the study, the patients were divided into two groups. Group I consisted of 31 patients who underwent membranectomy combined with routine transoortic myectomy. Group II consisted 13 patients to whom only excision of the subaortic membrane was done [membranectomy] without any myotomy or myectomy. Group II was done in Assuit University Hospital between 2001 and 2003. Group I was done in Paediatric cardiothoracic surgery unit [Children Hospital. Assuit University] between 2009 and 2013, in early postoperative results, the mean LVOT gradient in group I was statistically significantly lower than that of group II [p=0.000]. Aortic regurge [AR] improved in all patients of group I but progressed in five patients of group H. Mid-term follow up showed better results in group I than group II early resection of DMSS, before development of significant left ventricular hypertrophy and aortic insufficiency is advisable. Resection of the obstructing membrane together with generous myectomy of the LVOT is a safe and effective treatment in terms of more significant reduction of LVOT gradient; both early and in mid-term follow up, with lower incidence of recurrence and significant improvement of associated aortic incompetence

Endoscopy-guided balloon catheter dilatation of caustic oesophageal stricture in children

Between October 1997 and November 1998, 17 patients with symptomatic esophageal strictures underwent endoscopically and fluoroscopically guided balloon catheter dilatation. Their age range was between three and eight years with a mean age of 4.8 years. All the strictures were due to caustic ingestion, but the time of presentation after caustic ingestion varied until balloon catheter dilatation was applied. In sixteen patients, resolution or improvement of dysphagia was achieved with only one case needed surgery. There has been no patient morbidity or mortality after the procedure. It was concluded that balloon catheter dilatation under endoscopic and fluoroscopic guidance is a safe treatment of stricture. It should be considered the treatment of choice in the initial management of difficult esophageal narrowing and it appears to be safer than the more traditional methods of esophageal dilatation