Surgical treatment results of secondary tunnel-like subaortic stenosis after congenital heart disease operations / 中华胸心血管外科杂志

ABSTRACT

Objective To summarize surgical results of secondary tunnel-like subaortic stenosis( STSS) after congenital heart disease( CHD) operations, analyze the pathogenesis of STSS, evaluate the operative effect and prognosis.Methods We analyzed clinical data of 25 patients who underwent surgical repair for STSS in Fuwai Hospital from January 2009 to December 2015.There were 17 males and 8 females.CHD types included double outlet right ventricle, ventricular septal defect and par-tial atrioventricular septal defect, et al.The median age of the patients when they received their first CHD operations was 1 year (1 month to 42 years).The median age of the patients when they received TSS repair was 5 years and 8 months(2 years and 10 months to 48 years) .The surgical types contained modified Konno procedure , Konno procedure, resection of the conal sep-tum, resection of fibromuscular ridge and myectomy, removal and reconstruction of the intraventricular baffle.Results All the patients successfully received their TSS repair .There was no surgical death in this study .The preoperative gradient of aortic valve pressure was 81(43 to 159)mmHg(1 mmHg=0.133 kPa), and the postoperative gradient was 8.2(4.0 to 46.2) mm-Hg.Ⅲ degree atrioventricular block was occurred in 2 patients after operation and both 2 patients needed to set permanent pacemaker.All the patients were followed up after discharge for a median duration of 2 years( 4 months to 6 years) .During follow-up, none of the patients had any clinical symptom or subaortic restenosis , and there was no late death .Conclusion The pathogenesis of STSS is perhaps related to turbulent flow and shear stress to the left ventricular outflow tract , resulting in the proliferation of fibromuscular marterials and stenosis in the left ventricular outflow tract .The modified Konno procedure and resection of the conal septum are safe and effective.