Surgical treatment of subaortic stenosis: A seventeen-year experience

Sérraf, Alain; Zoghby, Joy; Lacour-Gayet, François; Houël, Rémi; Belli, Emrè; Galletti, Lorenzo; Planché, C

doi:10.1016/s0022-5223(99)70286-2

Cited by 97 publications

(102 citation statements)

References 30 publications

(30 reference statements)

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“…This has previously been demonstrated in several previous studies. 12,15,20,22,26,37 Furthermore, as expected, LVOT gradient progression postoperatively is a strong predictor for reoperation. In addition to the echocardiographic parameters to monitor and predict LVOT gradient progression, perhaps biomarkers might be useful for identifying those with more rapidly progressing disease.…”

Section: Dss Recurrence and Reoperationssupporting

confidence: 56%

Surgical Outcome of Discrete Subaortic Stenosis in Adults

et al. 2013

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Background-Discrete subaortic stenosis is notable for its unpredictable hemodynamic progression in childhood and high reoperation rate; however, data about adulthood are scarce. Methods and Results-Adult patients who previously underwent surgery for discrete subaortic stenosis were included in this retrospective multicenter cohort study. Mixed-effects and joint models were used to assess the postoperative progression of discrete subaortic stenosis and aortic regurgitation, as well as reoperation. Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.

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Section: Dss Recurrence and Reoperationssupporting

confidence: 56%

Surgical Outcome of Discrete Subaortic Stenosis in Adults

et al. 2013

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“…[2][3][4] The reasons behind the high recurrence rate are not well understood, 5 mainly due to the lesion's unknown etiology, either congenital or acquired. 2 3 6 7 Patients often become symptomatic later in life, 8 9 not allowing a definite etiological statement to be made.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Subaortic Stenosis

Weymann

Schmack

Rosendal

et al. 2013

ATCS

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A 63-year-old male patient with subaortic stenosis (Pmax 105 mmHg, Pmean 55 mmHg) and an aneurysm of the ascending aorta was referred to our hospital due to progressive angina pectoris. Transesophageal echocardiography demonstrated high and turbulent subaortic flow velocities. A calcified subaortic membrane was identified. The membrane was removed and the aneurysm was treated with a Bentall procedure. The patient recovered smoothly from surgery and was doing well 6 months after discharge.Keywords: subaortic stenosis, transesophageal echocardiography, bentall procedure IntroductionSubaortic stenosis is a very rare heart defect with a 1%-2% occurrence. In 70% of the cases, an isolated membrane is observed, which can result in a tunnellike obstruction of the left ventricular outflow tract (LVOT).1 Even with additional cardiac defects, surgical correction is a generally successful approach. Case ReportA 63-year-old male patient presented in our clinic, complaining of recent nocturia and progressive dyspnea accompanied by a retrosternal pressure pain. No heart rhythm disturbances were seen in the ECG. Coronary heart disease was ruled out.The transesophageal echocardiography demonstrated a normal sized, slightly concentric hypertrophic left ventricle with good pump function without wall motion abnormalities. The top part of the septum directly underneath the aortic valve level was hypertrophic (ca. 16 mm) taking on a ring-like shape (Fig. 1A). The left atrium was remarkably enlarged. The thickened aortic valve presented markedly reduced separation. Upon further inspection, an aneurysm of the ascending aorta was detected with a diameter of 53 mm. A significant flow acceleration in the LVOT was seen, with a mean and maximal gradient respectively of 55 mmHg and 105 mmHg (Fig. 1B). The mitral valve showed a SAM phenomenon with slight regurgitation.A Bentall procedure was performed using a mechanical conduit due to the ascending aortic aneurysm and a heavily calcified non-coronary sinus. The subvalvular membrane was resected ( Fig. 2A) and the LVOT was enlarged through a deep septal myectomy underneath the right coronary sinus. The procedure was completed with a decalcification of the anterior mitral valve leaflet (Fig. 2B). The pathology report of the resected membrane revealed hyaline and myxoid changes as well as calcifications and subendocardial and perivascular interstitial fibrosis and clear signs of hypertrophy. The postoperative transesophageal echocardiography did not show any remaining LVOT flow acceleration or a SAM phenomenon. The patient's LVOT widened significantly following the operation. The aortoseptal angle formed by the long axis of the ascending aorta and the plane of the ventricular septum also flattened postoperatively. As can be seen from the postoperative ECG, there were A 63-year-old male patient with subaortic stenosis (Pmax 105 mmHg, Pmean 55 mmHg) and an aneurysm of the ascending aorta was referred to our hospital due to progressive angina pectoris. Transesophageal echocardiography demonstrated ...

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“…Congenital subaortic stenosis has been associated with accessory mitral valve structure or malaligned VSD with division of the conus septum [1]. Secondary subaortic stenosis can develop following viral infection, infective endocarditis or surgery [5,6].…”

Section: Discussionmentioning

confidence: 99%

Severe subaortic stenosis that progressed over a 12-year period after cardiac surgery

et al. 2009

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A 12-year-old girl who had undergone cardiac surgery for ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA) in infancy was referred to our institution for fatigue and excessive sweating. Transthoracic and transesophageal echocardiographic studies revealed tunnel-type subaortic stenosis with aortic valvular stenosis, for which she underwent aortic valve replacement and myomectomy of left ventricular outflow tract. Progression of subaortic stenosis should be considered in patients with only mild aortic valve stenosis after previous cardiovascular surgery. Echocardiography contributed significantly to making the diagnosis and therapeutic decision in our patient.

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Surgical treatment of subaortic stenosis: A seventeen-year experience

Abstract: Although surgical treatment provides good results, recurrence and reoperation are significantly influenced by previous coarctation repair and by the quality of initial relief of subaortic stenosis.

Cited by 97 publications

References 30 publications

Surgical Outcome of Discrete Subaortic Stenosis in Adults

Surgical Outcome of Discrete Subaortic Stenosis in Adults

Surgical Management of Subaortic Stenosis

Severe subaortic stenosis that progressed over a 12-year period after cardiac surgery

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