Outcomes and Questions About Discrete Subaortic Stenosis

Foker, John E.

doi:10.1161/circulationaha.113.001619

Cited by 23 publications

(44 citation statements)

References 22 publications

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“…AR in patients with DSS has often been attributed to a jet effect and turbulence created by the obstructive subaortic tissue that progressively damages the valve leaflets, ultimately resulting in incompetence 18. This hypothesis has led many clinicians to recommend surgical resection of DSS to circumvent the development or worsening of AR.…”

Section: Discussionmentioning

confidence: 99%

“…However, little information exists regarding factors associated with haemodynamically significant AR in these patients. The high prevalence of AR (40–80%) has been attributed to the jet-effect on the aortic leaflets created by the obstructive lesion, as noted by studies demonstrating an association between higher preoperative gradient and increased risk of AR progression 2 4 11 13 15 18 19. However, few studies have examined the effects of concomitant congenital anomalies of the AoV on AR in this group of patients.…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children

Pickard

Geva

Nido

et al. 2015

Heart

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children

Pickard

Geva

Nido

et al. 2015

Heart

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“…Some studies found age ˂ 5 years at subaortic stenosis repair to be an independent predictor of subaortic stenosis reoperation. As left ventricular outflow tract obstruction appears to gradually increase at rate of 1 to 3 mmHg per year, it is logical that disease beginning at an earlier age would lead to increased risk of reoperation [16].…”

Section: Discussionmentioning

confidence: 99%

Results of Aortic Diaphragm Surgery in Senegal: About 20 Cases

Sokhna¹

2018

CCR

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Introduction: The subaortic diaphragm is a semilunar or circular membrane that is inserted into both the septal wall of the left ventricle and the base or adjacent part of the ventricular surface of the large mitral valve. It represents for 8-20% of all obstacles to left ventricular ejection. Material And Methods: This is a retrospective and descriptive study of patients with aortic stenosis under aortic diaphragmatic surgery operated over an 11-year period (January 2004-December 2015. Our study included 20 patients, 13 of which were male. The sex ratio was 1.85. The average age of patients was 16.6 years [4-51 years]. Stage 2 dyspnea (NYHA) was the primary reason for consultation (17 patients). The heartbeat was regular sinus rhythm in 17 patients. Transthoracic echocardiography (TTE) found left ventricular hypertrophy in 19 patients. The average transaortic gradient was 55.68mmHg [24 -92.5 mmHg]. Aortic insufficiency (IA) was found in 14 patients. An associated congenital heart defect was found in 9 patients. The approach was vertical median sternotomy and transverse aortotomy. The diaphragm was circular in 12 patients and semicircular in 8 patients. The aortic valve was tricuspid in 18 patients and bicuspid in 2 patients. The mean duration of extracorporeal circulation (ECC) was 74.66 minutes [35-119mn] and the mean duration of aortic cross-clamping was 49.11 minutes [20-102mn]. Results: After surgery, disorders of rhythm and conduction were present in 6 patients. At transthoracic ultrasound, left ventricular dysfunction was noted in 3 patients. A tamponade occurred in 1 patient justifying emergency drainage. Two recurrences of subaortic diaphragm were noted, one of which was reoperated after 9 years with a resection of the membrane and a replacement of the aortic valve by a mechanical prosthesis. One death was recorded four days postoperatively. The average postoperative gradient was 21.46mmhg. The average follow-up time was 38 months [5 months -115 months].

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“…At follow-up periods ranging from 2 to 5 years, no patients required repeat resection for recurrence in a report of 37 patients who underwent membrane resection and aggressive septal myectomy 23. One proposed rationale for this surgical approach postulates that more extensive resection that leaves less residual LVOT obstruction may decrease or at least delay recurrence, since the development of a subaortic membrane may represent a response to haemodynamic stress in the LVOT 24. In contrast, a recent retrospective multicentre study across Europe and Canada, designed to evaluate an adult population, argues that more extensive myocardial resection neither produced greater symptom relief nor decreased rates of reoperation, while leading to a higher risk of complete heart block necessitating pacemaker placement 20.…”

Section: Discussionmentioning

confidence: 99%

Subaortic membrane mimicking hypertrophic cardiomyopathy

2015

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A 34-year-old man was referred for progressive angina and exertional dyspnoea refractory to medical therapy, with a presumptive diagnosis of hypertrophic cardiomyopathy (HCM). Transthoracic echocardiography (TTE) revealed asymmetric septal hypertrophy without systolic anterior motion of the mitral valve leaflet and with no dynamic left ventricular outflow tract (LVOT) obstruction. However, the LVOT velocity was elevated at rest as well as with provocation, without the characteristic late peaking obstruction seen in HCM. Focused TTE to evaluate for suspected fixed obstruction demonstrated a subaortic membrane 2.2 cm below the aortic valve. Coronary CT angiography confirmed the presence of the subaortic membrane and was negative for concomitant coronary artery disease. Surgical resection of the subaortic membrane and septal myectomy resulted in significant symptomatic relief and lower LVOT velocities on postoperative TTE. This case reminds the clinician to carefully evaluate for alternative causes of LVOT obstruction, especially subaortic membrane, as a cause of symptoms mimicking HCM.

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Outcomes and Questions About Discrete Subaortic Stenosis

Cited by 23 publications

References 22 publications

Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children

Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children

Results of Aortic Diaphragm Surgery in Senegal: About 20 Cases

Subaortic membrane mimicking hypertrophic cardiomyopathy

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