Abstract
Objective: The term “subaortic stenosis” includes a variety of obstructions of the left ventricular
outflow tract (LVOT), ranging from a short (discrete) subvalvular membrane to long,
tunnel-like narrowing. An association with other congenital lesions is frequent. We
reviewed the reported literature and describe our results, analyzing the nomenclature
of and risk factors for restenosis after surgical treatment. Methods: From 1994 to 2009, 81 children (53 males, 28 females; median age: 57 months, range
[r]: 5–204) underwent surgical relief of a subaortic stenosis. Patients were divided,
according to pathology, into short segment (group A, n = 42) and complex obstructions
(group B, n = 39), with the latter including long segment stenosis and/or associated
anomalies such as aortic coarctation, interrupted aortic arch or Shone's complex.
Results: Surgery resulted in a significant reduction of the gradient between the left ventricle
and the aorta in both groups (Δp group A: 51 ± 28 mmHg, group B: 46 ± 25 mmHg). There was no operative mortality.
One patient died in the early postoperative period due to pericardial tamponade. Median
follow-up was 90 months (r = 0.5–187). Twenty-five (31 %) patients required reoperation because of recurrent
stenosis after a median of 43 months (r = 0.5–128). Seven (16 %) patients belonging to group A developed restenosis, and
18 (46 %) in group B. Freedom from reoperation for all patients was 60 % after 10
years. 10 (40 %) of the patients of group B were ultimately treated with a Ross-Konno
reconstruction of the LVOT. Conclusion: Despite adequate surgical resection, recurrence of subaortic stenosis within several
years after initial surgical treatment is frequent, especially in patients with complex
lesions. In cases requiring reoperation, the surgical therapy is often extensive,
and even includes Ross-Konno reconstruction of the LVOT.
Key words
congenital heart disease - CHD - aortic valve and root - pediatric
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Dr. Klaus Valeske
Children's Heart Center and Cardiovascular Surgery
University Giessen/Marburg
Feulgenstraße 12
35385 Giessen
Germany
Telefon: +49 6 41 98 54 34 61
Fax: +49 6 41 98 54 34 69
eMail: klaus.valeske@chiru.med.uni-giessen.de
