Postoperative follow-up of fibromuscular subaortic stenosis

Department of Paediatrics, University of Toronto Faculty of Medicine, Hospital for Sick Children, Ontario, Canada.

OBJECTIVES. This study attempted to determine whether early subaortic resection at lower levels of obstruction reduces the rate of recurrence of subaortic stenosis or reduces secondary damage to the aortic valve, or both. BACKGROUND. Fibromuscular subaortic stenosis is a progressive condition, and at present it is unclear whether early operation reduces the recurrence rate along with decreasing the incidence of aortic insufficiency. METHODS. Thirty-seven patients with fibromuscular subaortic stenosis and no other significant cardiac abnormality who underwent open subaortic resection were evaluated. The preoperative, early and late postoperative catheterization or echocardiographic findings as well as the operative reports were reviewed. The median age at operation was 6.4 years (range 1.1 to 17.3). The entire group has been followed up postoperatively for a median of 5.2 years (range 1.1 to 11). Mean systolic gradients across the left ventricular outflow tract were used for the purpose of this study. RESULTS. There was a significant correlation between the preoperative mean systolic gradient and the incidence of preoperative aortic regurgitation and late postoperative aortic valve thickening as well as the incidence and degree of late postoperative aortic regurgitation. Late postoperative gradient and degree of aortic regurgitation correlated significantly with the follow-up interval. Aortic regurgitation was progressive in some patients despite subaortic resection. A preoperative mean gradient > 30 mm Hg provided a reasonable cutoff for the likelihood postoperatively of needing a reoperation, having a postoperative shelf, a thickened aortic valve, moderate aortic regurgitation or a gradient of > 10 mm Hg. CONCLUSIONS. Our results suggest that although early subaortic resection may not reduce the rate of recurrence of fixed subaortic stenosis, it is likely to reduce acquired damage to the aortic valve.

This article has been cited by other articles:

				Z. W. M. Laksman, C. K. Silversides, T. Sedlak, A. M. Samman, W. G. Williams, G. D. Webb, and P. P. Liu Valvular Aortic Stenosis as a Major Sequelae in Patients With Pre-Existing Subaortic Stenosis: Changing Spectrum of Outcomes J. Am. Coll. Cardiol., August 23, 2011; 58(9): 962 - 965. [Abstract] [Full Text] [PDF]

				Y. Hirata, J. M. Chen, J. M. Quaegebeur, and R. S. Mosca The role of enucleation with or without septal myectomy for discrete subaortic stenosis. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1168 - 1172. [Abstract] [Full Text] [PDF]

				T. Bharucha, S. Y. Ho, and J. J. Vettukattil Multiplanar review analysis of three-dimensional echocardiographic datasets gives new insights into the morphology of subaortic stenosis Eur Heart J Cardiovasc Imaging, September 1, 2008; 9(5): 614 - 620. [Abstract] [Full Text] [PDF]

				A. Dodge-Khatami, M. Schmid, V. Rousson, M. Fasnacht, C. Doell, U. Bauersfeld, and R. Pretre Risk factors for reoperation after relief of congenital subaortic stenosis Eur J Cardiothorac Surg, May 1, 2008; 33(5): 885 - 889. [Abstract] [Full Text] [PDF]

				A. Geva, C. J. McMahon, K. Gauvreau, L. Mohammed, P. J. del Nido, and T. Geva Risk Factors for Reoperation After Repair of Discrete Subaortic Stenosis in Children J. Am. Coll. Cardiol., October 9, 2007; 50(15): 1498 - 1504. [Abstract] [Full Text] [PDF]

				T. Karamlou, R. Gurofsky, A. Bojcevski, W. G. Williams, C. A. Caldarone, G. S. Van Arsdell, T. Paul, and B. W. McCrindle Prevalence and Associated Risk Factors for Intervention in 313 Children With Subaortic Stenosis Ann. Thorac. Surg., September 1, 2007; 84(3): 900 - 906. [Abstract] [Full Text] [PDF]

				R. Barkhordarian, H. Uemura, M. L. Rigby, B. Sethia, D. Shore, A. Goebells, and S. Yen Ho A retrospective review in 50 patients with subaortic stenosis and intact ventricular septum: 5-year surgical experience Interact CardioVasc Thorac Surg, February 1, 2007; 6(1): 35 - 38. [Abstract] [Full Text] [PDF]

				J. Aboulhosn and J. S. Child Left Ventricular Outflow Obstruction: Subaortic Stenosis, Bicuspid Aortic Valve, Supravalvar Aortic Stenosis, and Coarctation of the Aorta Circulation, November 28, 2006; 114(22): 2412 - 2422. [Full Text] [PDF]

				J. M. Oliver, A. Gonzalez, P. Gallego, A. Sanchez-Recalde, F. Benito, and J. M. Mesa Discrete subaortic stenosis in adults: increased prevalence and slow rate of progression of the obstruction and aortic regurgitation J. Am. Coll. Cardiol., September 1, 2001; 38(3): 835 - 842. [Abstract] [Full Text] [PDF]

				D. KITCHINER Subaortic stenosis: still more questions than answers Heart, December 1, 1999; 82(6): 647 - 648. [Full Text]

				C V Rohlicek, S F. del Pino, M Hosking, J Miro, J-M Cote, and J Finley Natural history and surgical outcomes for isolated discrete subaortic stenosis in children Heart, December 1, 1999; 82(6): 708 - 713. [Abstract] [Full Text]

				A. Serraf, J. Zoghby, F. Lacour-Gayet, R. Houel, E. Belli, L. Galletti, and C. Planche SURGICAL TREATMENT OF SUBAORTIC STENOSIS: A SEVENTEEN-YEAR EXPERIENCE J. Thorac. Cardiovasc. Surg., April 1, 1999; 117(4): 669 - 678. [Abstract] [Full Text] [PDF]

				M. Yacoub, O. Onuzo, B. Riedel, and R. Radley-Smith MOBILIZATION OF THE LEFT AND RIGHT FIBROUS TRIGONES FOR RELIEF OF SEVERE LEFT VENTRICULAR OUTFLOW OBSTRUCTION J. Thorac. Cardiovasc. Surg., January 1, 1999; 117(1): 126 - 133. [Abstract] [Full Text] [PDF]

				G. S. Van Arsdell, W. G. Williams, C. Boutin, G. A. Trusler, J. G. Coles, I. M. Rebeyka, and R. M. Freedom SUBAORTIC STENOSIS IN THE SPECTRUM OF ATRIOVENTRICULAR SEPTAL DEFECTSSolutions may be complex and palliative J. Thorac. Cardiovasc. Surg., November 1, 1995; 110(5): 1534 - 1542. [Abstract] [Full Text]