Late results after resection of discrete and tunnel subaortic stenosis

Abstract

From May 1969 to June 1988, 84 consecutive patients ranging in age from 6 months to 61 years (mean 18 years) underwent surgery for fixed subaortic stenosis (SAS). A discrete fibrous or fibromuscular structure was present in 81 patients, while 3 presented with a tunnel type of obstruction. SAS was treated by sharp resection of the tissue and routine myotomy or myectomy of the hypertrophied left ventricular (LV) muscle (57 patients, group 1), while more recently, the lesion was treated by simple fibrous tissue enucleation (27 cases, group 2). There were 3 hospital deaths (3.6%) and 3 late deaths (overall mortality 7.1%). Eight patients required late reoperation because of recurrent SAS [3], aortic valve stenosis [2], aortic incompetence (AI) [2] and persistent mitral incompetence [1]. Seventy of 78 late survivors were reevaluated 3 months to 110 months after surgery (mean 75 +/- 48 months) by means of a complete cardiac catheterization or by 2-D echo and Doppler. The transaortic peak pressure gradient decreased from 97 +/- 43 (range 20-205 mmHg) to 11 +/- 16 mmHg (range 0-60 mmHg) in group 1 and from 72 +/- 38 mmHg (range 18-160 mmHg) to 3 +/- 7 mmHg (range 0-25 mmHg) in group 2 (P = NS). In 55 patients who have not undergone surgery on the aortic valve, AI remained unchanged in 31, decreased from mild to nil in 21 and from moderate to mild in 3. We conclude that simple blunt enucleation of SAS is an effective procedure in relieving LV outflow obstruction even if a myotomy or myectomy of the underlying hypertrophied muscle is not routinely used.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical Outcome of Discrete Subaortic Stenosis in Adults

“…12 Although some previous studies have suggested that additional myectomy during the first operation reduces the incidence of recurrence, other authors have questioned this finding. 8,[16][17][18][19][20][21][22][23][24][25][26][27] Our results do not support the benefit of additional myectomy for either the risk of reoperation or LVOT gradient progression rate postoperatively. A tradeoff when aggressive surgical resection is performed to potentially lower the recurrence rate is the risk of a complete atrioventricular block, which was significantly higher in the patients who underwent additional myectomy compared with those who underwent isolated enucleation (8% versus 2%).…”

La chirurgie du diaphragme sous aortique

“…Cependant, chez les patients présentant des anomalies cardiaques associées, la myectomie était plus efficace. Or, plusieurs auteurs attribuent à ces gestes de résection assez étendue des troubles de la conduction postopératoire; ainsi Stellin [ 11 ] n'est pas favorable à la réalisation systématique de ces gestes. Parry [ 12 ] a constaté qu'une résection agressive avec myectomie vaste s'accompagne d'un taux de BAV complet supérieur de 14% au taux rapporté par Ali Dodge-Khatami [ 4 ], Serraf [ 3 ] et Abid [ 1 ] qui était respectivement de 1.7, 2.5 et 8.9%; il souligne ainsi le compromis entre le risque de BAV et un taux de récidive potentiellement faible (aucune récidive) associée à une myectomie étendue.…”

“…Tous les autres n'ont pas eu d'aggravation de leur IA pendant la durée du suivi. Aucun des facteurs préopératoires testés (l’âge, le gradient préopératoire, la technique chirurgicale, l'anatomie et la fonction valvulaire préopératoire) n'ont influencé la fonction de la VA. Stellin [ 11 ], sur 55 IA préopératoires, a constaté 24 cas de régression, 31 cas de stabilité et sans aucun nouveau cas. Hansen [ 16 ], avec un recul moyen de 5ans après l'intervention, a rapporté l'apparition d'une IA chez 8 patients sur 13 qui n'avaient pas d'IA préopératoire.…”

Vincenzo Gallucci: Memories of a Surgeon, Scientist, and Teacher

“…24,25 Other important studies were produced on the results of surgical treatment in tricuspid atresia, double-outlet right ventricle, and tunnel subaortic stenosis and on the repair of mitral valve malformations in children. [26][27][28][29] After the first Italian HT, a pediatric HT program was allowed to perform, among the first in Europe, several successful transplants in young infants and neonates with end-stage congenital and acquired heart diseases. 30,31 Conclusions Vincenzo Gallucci spent most of his professional life at the University of Padua, consistently contributing to the growth of an important cardiovascular surgery program, maintaining the centennial academic role of this medical school, and even increasing its international reputation.…”