Late results after resection of discrete and tunnel subaortic stenosis

• Published in: European journal of cardio-thoracic surgery Vol. 3; no. 3; pp. 235 - 239
• Main Authors: STELLIN, G, MAZZUCCO, A, BORTOLOTTI, U, TISO, E, DALIENTO, L, MARAGLINO, G, MILANO, A, FAGGIAN, G, RIZZOLI, G, GALLUCCI, V
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Science B.V 1989; Elsevier Science
• Subjects: Adolescent; Adult; Aortic Stenosis, Subvalvular - complications; Aortic Stenosis, Subvalvular - surgery; Biological and medical sciences; Cardiology. Vascular system; Cardiomyopathy, Hypertrophic - surgery; Child; Child, Preschool; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Female; Follow-Up Studies; Heart; Heart Defects, Congenital - surgery; Heart Ventricles - surgery; Humans; Infant; Male; Medical sciences; Methods; Middle Aged; Reoperation; Ventricular Outflow Obstruction - surgery; Human; Aortic stenosis; Corrective surgery; Resection; Congenital; Heart disease; Cardiovascular disease; Subvalvular; Child
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/1010-7940(89)90072-9

From May 1969 to June 1988, 84 consecutive patients ranging in age from6 months to 61 years (mean 18 years) underwent surgery for fixed subaorticstenosis (SAS). A discrete fibrous or fibromuscular structure was presentin 81 patients, while 3 presented with a tunnel type of obstruction. SASwas treated by sharp resection of the tissue and routine myotomy ormyectomy of the hypertrophied left ventricular (LV) muscle (57 patients,group 1), while more recently, the lesion was treated by simple fibroustissue enucleation (27 cases, group 2). There were 3 hospital deaths (3.6%)and 3 late deaths (overall mortality 7.1%). Eight patients required latereoperation because of recurrent SAS [3], aortic valve stenosis [2], aorticincompetence (AI) [2] and persistent mitral incompetence [1]. Seventy of 78late survivors were reevaluated 3 months to 110 months after surgery (mean75 +/- 48 months) by means of a complete cardiac catheterization or by 2-Decho 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 1and from 72 +/- 38 mmHg (range 18-160 mmHg) to 3 +/- 7 mmHg (range 0- 25mmHg) in group 2 (P = NS). In 55 patients who have not undergone surgery onthe aortic valve, AI remained unchanged in 31, decreased from mild to nilin 21 and from moderate to mild in 3. We conclude that simple bluntenucleation of SAS is an effective procedure in relieving LV outflowobstruction even if a myotomy or myectomy of the underlying hypertrophiedmuscle is not routinely used.