Geometry of the left ventricular outflow tract in fixed subaortic stenosis and intact ventricular septum: An echocardiographic study in children and adults

Barkhordarian, Reza; Ding, Weijun; Li, Wei; Josen, M; Henein, Michael Y.; Ho, Siew Yen

doi:10.1016/j.jtcvs.2006.09.010

Cited by 36 publications

(41 citation statements)

References 25 publications

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“…12 Furthermore, the LVOT obstruction eventually leads to concentric left ventricular hypertrophy and remodeling over time, which could conceivably also contribute to the development of AR. 13,14 Barkhordarian et al 15 reported that in patients under 10 years of age with an isolated subaortic membrane, the AoSA did change after surgical removal of the membrane, suggesting that the LVOT geometry may be remodeled in younger patients. This might explain why steeper AoSA were not associated with subaortic membrane recurrence in an eight-year follow-up study by Geva et al 16 Furthermore, an interaction between hemodynamic and genetic stimuli may determine the fate of patients with abnormal AoSA.…”

Section: Discussionmentioning

confidence: 99%

Subaortic Membrane and Aorto-Septal Angle

Barboza

Garcia

Barnoya

et al. 2013

World J Pediatr Congenit Heart Surg

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Background: Development of a subaortic membrane is not fully understood. Recurrence after surgical removal continues to be high. We sought to assess the differences in aorto-septal angles (AoSA) to possibly explain alterations within the left ventricular outflow tract, hence in subaortic membrane formation. Methods: A total of 113 patients who underwent subaortic membrane resection were matched by age and sex with 113 controls. The subaortic membrane resection group included isolated subaortic membranes (n ¼ 34, group I), associated with ventricular septal defect (n ¼ 29, group II), or patent ductus arteriosus (n ¼ 50, group III). Results: Mean (+ standard deviation) AoSA (in degrees) were not different between subaortic membrane groups I, II, and III but were steeper than their control groups (126.2 + 9.2 vs 138.6 + 7.0, 129.2 + 9.9 vs 137.7 + 10.0, and 126.2 + 8.1 vs 135 + 8.5, respectively; all Ps < .05). Additionally, group II had lower preoperative gradients (28.8 + 20.7 mm Hg) compared to groups I and III (67.0 + 32.9 and 66.2 + 33.1 mm Hg, respectively, P < .001). Follow-up ranged from 3 to 132 months. In 22 (32%) patients, a subaortic membrane recurred. Early postoperative residual gradients and development of aortic regurgutation were associated with the need for reoperation (P < .05). Conclusions: These findings suggest a contributing role of the AoSA in the development of subaortic membrane. Further rheological experiments are warranted. Whether the steeper the angle the higher the risk of recurrence may be revealed by longer follow-up periods.

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Section: Discussionmentioning

confidence: 99%

Subaortic Membrane and Aorto-Septal Angle

Barboza

Garcia

Barnoya

et al. 2013

World J Pediatr Congenit Heart Surg

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“…The right ventricular outflow is preserved without a septal incision and without the moiety that is required for the "apron extension" shown in Figure 30 accounts for 15-20% of all cases of LVOTO [133]. The most common form of subvalvar stenosis is a fixed obstruction due to abnormally present fibromuscular structures in the LVOT.…”

Section: Ross and Ross-konno Proceduresmentioning

confidence: 99%

“…Stress level increases were consistent with cellular flow studies showing growth factor stimulation and cellular proliferation. Echocardiographic studies in patients with fixed subaortic stenosis and intact ventricular septum suggest that, in addition to a steepened aortoseptal angle, these patients also have a significantly wider mitral-aortic separation, a marked aortic valve dextroposition, an increased left ventricular wall thickness, an increased septal thickness, and a smaller LVOT width [133]. A steepsteepened aortoseptal angle in patients up to 10 years of age [133].…”

Section: Pathophysiologymentioning

confidence: 99%

Left Ventricular Outflow Tract Obstruction

Tchervenkov

Bernier

Del

et al. 2012

Pediatric Cardiac Surgery

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“…1 In reality, subaortic membrane is not congenital but an acquired lesion that forms due to steep angel between left ventricle and aorta. 2 Turbulence of blood flow at this angel results in endocardial injury that initiates fibrosis and ultimately membrane formation.…”

Section: Introductionmentioning

confidence: 99%

Subaortic Membrane; Surgical Results of Resection. A Single Centre Experience.

Waqar¹

2017

TPMJ

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ABSTRACT… Objectives:In this study, we presented our results regarding outcomes of surgical correction of sub-aortic membrane. Study Design: Retrospective observational study. Period: June 2012 to June 2017. Setting: CPEIC Multan, Pakistan. Methods: 51 patients operated for resection of sub aortic membrane. The resection of sub aortic membrane was done through the aorta. Evaluation of the aortic valve done in all patients. The aortic valve was either replaced or repaired in cases of severe aortic regurgitation. Associated lesions such as ventricular septal defects (VSD's) were repaired with a dacron patch through the right atrium while ASD's were repaired with a pericardial patch. Post-operative echocardiography was done before discharge and post-op LVOT gradients and aortic insufficiency were recorded for all the patients. Results: There were 36 males and 15 females whose mean ages were 16.29 years. On post-op echocardiography there was no residual significant LVOT gradient in any patient. Three (3) patients developed mild to moderate aortic regurgitation post operatively but none of them warrant any surgical intervention. There was only 1 death in the series which was due to VSD patch dehiscence. None of the patients developed conduction problems post operatively needing any permanent pace maker. Mean pre-op LVOT gradient was 94.7 mmHg while it reduced to 20.7 post operatively (p-value <0.001). Conclusion: We concluded that early resection of sub aortic membrane can be safely accomplished with good results and significant drop in the mean LVOT pressure gradients post operatively. Key words:Left Ventricle Outflow Obstruction, Aortic Regurgitation, Bacterial Endocarditis.

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Geometry of the left ventricular outflow tract in fixed subaortic stenosis and intact ventricular septum: An echocardiographic study in children and adults

Cited by 36 publications

References 25 publications

Subaortic Membrane and Aorto-Septal Angle

Subaortic Membrane and Aorto-Septal Angle

Left Ventricular Outflow Tract Obstruction

Subaortic Membrane; Surgical Results of Resection. A Single Centre Experience.

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