ABSTRACT
OBJECTIVE: The term "subaortic stenosis" includes a variety of obstructions of the left ventricular outflow tract (LVOT), ranging from a short (discrete) subvalvular membrane to long, tunnel-like narrowing. An association with other congenital lesions is frequent. We reviewed the reported literature and describe our results, analyzing the nomenclature of and risk factors for restenosis after surgical treatment. METHODS: From 1994 to 2009, 81 children (53 males, 28 females; median age: 57 months, range [ R]: 5-204) underwent surgical relief of a subaortic stenosis. Patients were divided, according to pathology, into short segment (group A, n = 42) and complex obstructions (group B, n = 39), with the latter including long segment stenosis and/or associated anomalies such as aortic coarctation, interrupted aortic arch or Shone's complex. RESULTS: Surgery resulted in a significant reduction of the gradient between the left ventricle and the aorta in both groups (Δ P group A: 51 ± 28 mmHg, group B: 46 ± 25 mmHg). There was no operative mortality. One patient died in the early postoperative period due to pericardial tamponade. Median follow-up was 90 months (R = 0.5-187). Twenty-five (31%) patients required reoperation because of recurrent stenosis after a median of 43 months (R = 0.5-128). Seven (16%) patients belonging to group A developed restenosis, and 18 (46%) in group B. Freedom from reoperation for all patients was 60% after 10 years. 10 (40%) of the patients of group B were ultimately treated with a Ross-Konno reconstruction of the LVOT. CONCLUSION: Despite adequate surgical resection, recurrence of subaortic stenosis within several years after initial surgical treatment is frequent, especially in patients with complex lesions. In cases requiring reoperation, the surgical therapy is often extensive, and even includes Ross-Konno reconstruction of the LVOT.
Subject(s)
Aortic Stenosis, Subvalvular/surgery , Cardiac Surgical Procedures , Discrete Subaortic Stenosis/surgery , Ventricular Outflow Obstruction/surgery , Adolescent , Aortic Stenosis, Subvalvular/classification , Aortic Stenosis, Subvalvular/diagnosis , Aortic Stenosis, Subvalvular/mortality , Aortic Stenosis, Subvalvular/physiopathology , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Chi-Square Distribution , Child , Child, Preschool , Discrete Subaortic Stenosis/classification , Discrete Subaortic Stenosis/diagnosis , Discrete Subaortic Stenosis/mortality , Disease-Free Survival , Female , Germany , Humans , Infant , Kaplan-Meier Estimate , Male , Recurrence , Reoperation , Risk Assessment , Risk Factors , Terminology as Topic , Time Factors , Treatment Outcome , Ventricular Outflow Obstruction/classification , Ventricular Outflow Obstruction/diagnosis , Ventricular Outflow Obstruction/mortality , Ventricular Outflow Obstruction/physiopathologySubject(s)
Aortic Stenosis, Subvalvular/diagnosis , Aortic Valve Stenosis/diagnosis , Cardiomyopathy, Hypertrophic/diagnosis , Echocardiography , Adult , Aged , Aortic Stenosis, Subvalvular/classification , Aortic Valve/abnormalities , Aortic Valve Stenosis/congenital , Calcinosis/diagnosis , Cardiomyopathies/diagnosis , Child , Hemodynamics , HumansABSTRACT
Twenty-three patients with congenital subvalvular aortic stenosis are reviewed. The importance of classifying this stenosis into four types based on angiocardiographic findings is stressed, as are the indications for left heart catheterization during the preoperative and postoperative course of the disease. The type of congenital subvalvular aortic stenosis should be an important consideration during the discussion of operative indications in both asymptomatic and symptomatic patients.
