Long-term results after excision of fixed subaortic stenosis

Ashraf, Haris; Cotroneo, Joseph V.; Dhar, Nivedita; Gingell, Robert L.; Roland, M; Pieroni, Daniel R.; Subramanian, S.

doi:10.1016/s0022-5223(19)38511-3

Cited by 45 publications

(20 citation statements)

References 20 publications

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“…However, 42 of our patients were asymptomatic (47.7%), the rate of symtomatic patients were reported in variables from 39% to 70% other series 9–11 . Subvalvular aortic stenosis often coexists with a variety 45% to 62% of congenital anomalies with varied rates 2,6–11,15 . Only 55% patients of our series had isolated subvalvular aortic stenosis.…”

Section: Discussionmentioning

confidence: 58%

“…It has been stated that progression of AI could be slowed with adequate resection of SAS 2 . On the other hand, it has been noted that AI could progress postoperatively despite relief of the LVOT stenosis 7 . Oliver et al 21 reported that surgical repair of discrete SAS in children did not prevent AI development in adults.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical intervention prevents the abnormal muscular hypertrophy, reduces the incidence of aortic insufficiency (AI), and protects the patients against bacterial endocarditis 3 . Several studies have documented relief of outflow gradient and improvement after surgery 2–11 . We have reviewed the clinical, pathological, and operative finding of 88 patients undergoing surgery for SAS and analyzed the long‐term results of relief and the risk factors associated with recurrence and reoperation over a 15‐year period.…”

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confidence: 99%

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Surgical Treatment of Subaortic Obstruction in Adolescent and Adults: Long-Term Follow-up

Erentuğ

Bozbuğa

Kırali

et al. 2005

Journal of Cardiac Surgery

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Subaortic stenosis (SAS) is a wide spectrum of anatomical derangements ranging from a discrete fibrous membrane to tortuous fibrous tunnel with or without aortic annulus hypoplasia. We have reviewed 88 patients undergoing surgery for SAS over a 15-year period. There were 47 male and 41 female patients with a mean age of 19.8 +/- 10.6 years (range 11 to 39). Fifty-eight patients had discrete subaortic membrane, and 30 patients had diffuse tunnel subvalvular stenosis. The mean systolic pressure gradients were found to be 86.5 +/- 31.4 mmHg (range 48 to 145 mmHg). Ten patients had mild and 13 patients had moderate-to-severe aortic insufficiency (AI) preoperatively. Nine patients had bicuspid aortic valve. Forty patients (45.4%) had associated cardiac lesions. Isolated membranectomy was performed in six patients. Membranectomy associated with septal myectomy was done in 52 patients. Fifteen patients of them associated hypoplasia of the aortic orifice necessitated aortic valve replacement (AVR) using the Konno-Rastan procedure. Fifteen patients with tunnel SAS and normal aortic valves underwent a combined approach for valve sparing, a modified Konno procedure with patch septoplasty. Also eight patients required AVR because of the severity of AI and five patients aortic reconstruction procedures. Aortic commissurotomy was performed to relief of stenosis in four patients. There were three early deaths (3.4%) and one late death (1.1%) all after the Konno-Rastan procedure. Eight patients (9.1%) had permanent conduction abnormalities. Postoperative left ventricle-aorta gradient was significantly decreased at early postoperative period (p < 0.001) and ranged from 10 to 25 mmHg (mean 14.1 +/- 4.3). Fourteen patients (16.5%) were reoperated for recurrent obstruction or progression of AI. The mean reoperation interval was 4.4 +/- 1.7 years (range 2 to 8 years). Five-year reoperation-free survival was 88.0 +/- 3.6% and 12.5-year reoperation-free survival was 75.5 +/- 7.0%. Our results of aggressive surgical approach of subvalvular aortic stenosis produces relief of obstruction and frees the valve leaflets, significantly reducing associated AI with long-term survival and long-term adequate relief of left ventricular outflow tract obstruction.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Surgical Treatment of Subaortic Obstruction in Adolescent and Adults: Long-Term Follow-up

Erentuğ

Bozbuğa

Kırali

et al. 2005

Journal of Cardiac Surgery

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“…The reported rate of postoperative recurrence of gradients for discrete SubAM ranges from 5% to 36% and reoperation rates have ranged from 0% to 31% . However, these results include not only isolated discrete SubAM but also patients with coexisting congenital diseases.…”

Section: Discussionmentioning

confidence: 99%

Resection of subaortic membrane for discrete subaortic stenosis

et al. 2017

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“…9 Every attempt should be made to surgically remove as much obstructive tissue as possible during surgery and to maximally reduce the postoperative gradient in order to reduce the rate of postoperative recurrence. 10 In one study of37 patients, surgical removal ofthe subvalvular membrane alone was associated with a 36% recurrence rate, whereas surgical left ventricular myomectomy plus membrane removal was associated with a 20% recurrence rate. 6 Regardless of the surgical procedure performed, progression occurred.…”

Section: Pressure Tracings Obtained At Catheterization As Catheter Wamentioning

confidence: 99%

Chest pain secondary to membranous subaortic stenosis in a young woman

Brodyn

Haft²

1992

Journal of Osteopathic Medicine

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Left ventricular outflow obstruction can be divided into three distinct categories: valvular aortic stenosis, the most common form; supravalvular aortic stenosis, which is often seen in early childhood; and subvalvular stenosis, which can be further subdivided into muscular, tunnel, and fibromembranous subtypes. All may be found in a patient seen with symptoms of angina, syncope, or heart failure as a precursor to sudden death. Prompt clinical recognition is essential as is a high degree of suspicion when these signs are associated with a systolic ejection murmur on clinical examination. Echocardiography and a meticulous Doppler examination are very useful in the diagnosis of these disorders as well as in further distinguishing among the different subtypes. The authors describe the case of a 40-yearold woman with chest pain refractory to medical therapy and a long systolic ejection murmur.

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Long-term results after excision of fixed subaortic stenosis

Cited by 45 publications

References 20 publications

Surgical Treatment of Subaortic Obstruction in Adolescent and Adults: Long-Term Follow-up

Surgical Treatment of Subaortic Obstruction in Adolescent and Adults: Long-Term Follow-up

Resection of subaortic membrane for discrete subaortic stenosis

Chest pain secondary to membranous subaortic stenosis in a young woman

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