Surgical Results of Secondary Subaortic Stenosis after Congenital Heart Disease Operations_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Dandong , CHEN Jimei , CEN Jianzheng , DING Yiqun , ZHU Weizhong , WU Lan , ZHUANG Jian.

Department of Cardiac Surgery，Guangdong Cardiovascular Institute，Guangdong General Hospital，Guangdong Academy of Medical Sciences，Guangzhou510100，P. R. China;

Corresponding author：

Keywords：

Congenital heart defect; 　Subaortic stenosis; 　Cardiac surgery

DOI：

10.7507/1007-4848.20130199

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Abstract： Objective To summarize surgical results of secondary subaortic stenosis （SSS） after congenital heart disease （CHD） operations，and analyze the pathogenesis of SSS. Methods We retrospectively analyzed clinical data of 19 patients who underwent surgical repair for SSS in Guangdong General Hospital from 1st June 2008 to 31st December 2012. There were 10 males and 9 females. CHD types included double outlet right ventricle，ventricular septal defect and partial atrioventricular septal defect，et al. The median age of the patients when they received their first CHD operations was 4 months （15 days to 5 year and 11 months）. The median age of the patients when they received SSS repair was 5 years and 3 months （1 year to 15 years and 3 months）. The median time interval from CHD operation to SSS repair was 4 years and 10 months （8 months to 13 years and 11 months）. Results All the patients successfully received their SSS repair. There was no surgical death in this study. Median cardiopulmonary bypass time was 79 （39 to 172） minutes，and median aortic cross-clamp time was 42 （22 to 124） minutes. Median postoperative hospital stay was 7 （5 to 9） days. Postoperatively， 1 patient required permanent pacemaker implantation. All the patients were followed up after discharge for a median durationof 1 year and 10 months （5 months to 4 years and 4 months） . During follow-up， none of the patients had any clinical symptom，their heart function was normal，and there was no late death. One patient received another subaortic stenosis repair for gradually aggravating left ventricular outflow tract stenosis. Conclusions SSS is very rare after CHD operations. The pathogenesis of SSS is perhaps related to abnormal blood flows in the left ventricular outflow tract after CHD operations. The pathogenesis time of SSS and types of CHD leading to SSS cannot be predicted. Subaortic stenosis repair is a simple and safe procedure for SSS，but postoperatively left ventricular outflow tract stenosis may appear and aggravate again.

Citation： LUO Dandong,CHEN Jimei,CEN Jianzheng,DING Yiqun,ZHU Weizhong,WU Lan,ZHUANG Jian.. Surgical Results of Secondary Subaortic Stenosis after Congenital Heart Disease Operations. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 623-627. doi: 10.7507/1007-4848.20130199 Copy

1.	李令珂，于鲁峰，陈元恒，等. 纤维隔膜性主动脉瓣下狭窄合并室间隔缺损9例. 中国胸心血管外科临床杂志， 2001， 8 （3）：214．.
2.	Uysal F， Bostan OM， Signak IS， et al. Evaluation of subvalvular aortic stenosis in children：a 16-Year Single-Center experience. Pediatr Cardiol， 2013. [Epub ahead of print].
3.	Lim DS， Ensing GJ， Ludomirsky A， et al. Echocardiographic predi-ctors for the development of subaortic stenosis after repair of atrioven-tricular septal defect. Am J Cardiol， 2003， 91 （7）：900-903.
4.	De Mey N， Couture P， Denault AY， et al. Subaortic stenosis after atrioventricular septal defect repair. Anesth Analg， 2011， 113 （2）：236-238.
5.	Kalfa D， Ghez O， Kreitmann B， et al. Secondary subaortic stenosis in heart defects without any initial subaortic obstruction：a multifactorial postoperative event. Eur J Cardiothorac Surg， 2007， 32 （4）：582-587.
6.	Birim O， van Gameren M， de Jong PL， et al. Outcome after reoperation for atrioventricular septal defect repair. Interact Cardiovasc Thorac Surg， 2009， 9 （1）：83-87.
7.	Sato Y， Matsumoto N， Iida J， et al. Discrete subaortic stenosis afterthe correction of atrioventricular septal defect in an adult. Int J Cardiol，2006， 109 （2）：291-292.
8.	Bertrand S， Anderson RH， de Leval MR. Subneoaortic stenosis complicating the arterial Switch operation. Cardiol Young， 2005， 15 （6）：663-665.
9.	Kim KH， Kim HK， Chang SA， et al. Subaortic membrane late after surgical correction of tetralogy of fallot. Korean J Intern Med， 2012， 27 （4）：455-458.
10.	Sangem M， Salim MA， Love JC， et al. Transient dynamic subaortic stenosis in premature neonates after patent ductus arteriosus ligation. Pediatr Cardiol， 2008， 29 （5）：989-992.
11.	Laksman ZW， Silversides CK， Sedlak T， et al. Valvular aortic stenosis as a major sequelae in patients with pre-existing subaortic stenosis changing spectrum of outcomes. J Am Coll Cardiol， 2011， 58 （9）：962-965.
12.	Watanabe M， Harada Y， Takeuchi T， et al. Mitral annular aneurysmresulting from subaortic muscle resection. Ann Thorac Surg， 2002， 73 （4）：1302-1303.
13.	Chaudhuri D， Fink G， Liu K. Discrete subaortic stenosis in a patient with a history of repaired AV canal defect. Echocardiography， 2011， 28 （9）：E196-E197.
14.	Kanemitsu S， Yamamoto K， Shimono T， et al. Discrete subaortic stenosis 37 years after repair of a ventricular septal defect. Interact Cardiovasc Thorac Surg， 2012， 14 （5）：683-685.
15.	de Lezo JS， Romero M， Segura J， et al. Long-term outcome ofpatients with isolated thin discrete subaortic stenosis treated by balloondilation：a 25-year study. Indian Heart J， 2011， 124 （13）：1461-1468.
16.	Drolet C， Miro J， Côté JM， et al. Long-term pediatric outcome of isolated discrete subaortic stenosis. Can J Cardiol， 2011， 27 （3）：389.e19-389.e24.
17.	Lopes R， Lourenço P， Gonçalves A， et al. The natural history of congenital subaortic stenosis. Congenit Heart Dis， 2011， 6 （5）：417-423.
18.	Hirata Y， Chen JM， Quaegebeur JM， et al. The role of enucleation with or without septal myectomy for discrete subaortic stenosis. J Thorac Cardiovasc Surg， 2009， 137 （5）：1168-1172.
19.	Geva A， Mcmahon CJ， Gauvreau K， et al. Risk factors for reoperation after repair of discrete subaortic stenosis in children. J Am Coll Cardiol， 2007， 50 （15）：1498-1504.
20.	Brown JW， Ruzmetov M， Vijay P， et al. Surgery for aortic stenosis in children：a 40-year experience. Ann Thorac Surg， 2003， 76 （5）：1398-1411.

1. 　李令珂，于鲁峰，陈元恒，等. 纤维隔膜性主动脉瓣下狭窄合并室间隔缺损9例. 中国胸心血管外科临床杂志， 2001， 8 （3）：214．.
2. 　Uysal F， Bostan OM， Signak IS， et al. Evaluation of subvalvular aortic stenosis in children：a 16-Year Single-Center experience. Pediatr Cardiol， 2013. [Epub ahead of print].
3. 　Lim DS， Ensing GJ， Ludomirsky A， et al. Echocardiographic predi-ctors for the development of subaortic stenosis after repair of atrioven-tricular septal defect. Am J Cardiol， 2003， 91 （7）：900-903.
4. 　De Mey N， Couture P， Denault AY， et al. Subaortic stenosis after atrioventricular septal defect repair. Anesth Analg， 2011， 113 （2）：236-238.
5. 　Kalfa D， Ghez O， Kreitmann B， et al. Secondary subaortic stenosis in heart defects without any initial subaortic obstruction：a multifactorial postoperative event. Eur J Cardiothorac Surg， 2007， 32 （4）：582-587.
6. 　Birim O， van Gameren M， de Jong PL， et al. Outcome after reoperation for atrioventricular septal defect repair. Interact Cardiovasc Thorac Surg， 2009， 9 （1）：83-87.
7. 　Sato Y， Matsumoto N， Iida J， et al. Discrete subaortic stenosis afterthe correction of atrioventricular septal defect in an adult. Int J Cardiol，2006， 109 （2）：291-292.
8. 　Bertrand S， Anderson RH， de Leval MR. Subneoaortic stenosis complicating the arterial Switch operation. Cardiol Young， 2005， 15 （6）：663-665.
9. 　Kim KH， Kim HK， Chang SA， et al. Subaortic membrane late after surgical correction of tetralogy of fallot. Korean J Intern Med， 2012， 27 （4）：455-458.
10. 　Sangem M， Salim MA， Love JC， et al. Transient dynamic subaortic stenosis in premature neonates after patent ductus arteriosus ligation. Pediatr Cardiol， 2008， 29 （5）：989-992.
11. 　Laksman ZW， Silversides CK， Sedlak T， et al. Valvular aortic stenosis as a major sequelae in patients with pre-existing subaortic stenosis changing spectrum of outcomes. J Am Coll Cardiol， 2011， 58 （9）：962-965.
12. 　Watanabe M， Harada Y， Takeuchi T， et al. Mitral annular aneurysmresulting from subaortic muscle resection. Ann Thorac Surg， 2002， 73 （4）：1302-1303.
13. 　Chaudhuri D， Fink G， Liu K. Discrete subaortic stenosis in a patient with a history of repaired AV canal defect. Echocardiography， 2011， 28 （9）：E196-E197.
14. 　Kanemitsu S， Yamamoto K， Shimono T， et al. Discrete subaortic stenosis 37 years after repair of a ventricular septal defect. Interact Cardiovasc Thorac Surg， 2012， 14 （5）：683-685.
15. 　de Lezo JS， Romero M， Segura J， et al. Long-term outcome ofpatients with isolated thin discrete subaortic stenosis treated by balloondilation：a 25-year study. Indian Heart J， 2011， 124 （13）：1461-1468.
16. 　Drolet C， Miro J， Côté JM， et al. Long-term pediatric outcome of isolated discrete subaortic stenosis. Can J Cardiol， 2011， 27 （3）：389.e19-389.e24.
17. 　Lopes R， Lourenço P， Gonçalves A， et al. The natural history of congenital subaortic stenosis. Congenit Heart Dis， 2011， 6 （5）：417-423.
18. 　Hirata Y， Chen JM， Quaegebeur JM， et al. The role of enucleation with or without septal myectomy for discrete subaortic stenosis. J Thorac Cardiovasc Surg， 2009， 137 （5）：1168-1172.
19. 　Geva A， Mcmahon CJ， Gauvreau K， et al. Risk factors for reoperation after repair of discrete subaortic stenosis in children. J Am Coll Cardiol， 2007， 50 （15）：1498-1504.
20. 　Brown JW， Ruzmetov M， Vijay P， et al. Surgery for aortic stenosis in children：a 40-year experience. Ann Thorac Surg， 2003， 76 （5）：1398-1411.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Results of Secondary Subaortic Stenosis after Congenital Heart Disease Operations

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