Mid- and long-term results of different techniques for subaortic stenosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Benqing , MA Kai , ZHANG Sen , YAN Jun , HUA Zhongdong ,  LI Shoujun

Department of Pediatric Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, 100037, P. R. China;

Corresponding author：

LI Shoujun, Email: drlishoujun@yahoo.com

Keywords：

Congenital heart disease; sub-valvular aortic stenosis; valvular membrane resection; muscles resection; modified Konno procedure

DOI：

10.7507/1007-4848.202007092

Video：

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Objective To evaluate the mid- and long-term outcomes of different surgical techniques for subaortic stenosis.Methods The clinical data of 75 patients with subaortic stenosis who underwent surgery in our hospital from January 2008 to January 2018 were retrospectively analyzed, including 48 males and 27 females, with a median age of 72 (48, 132) months and mean weight of 21.35±15.82 kg. There were 40 (53.3%) patients combined with aortic regurgitation; 38 (50.7%) patients were the first time and 37 patients were the second time to receive the operation. According to the surgical techniques, 75 patients were divided into two groups: a group A (40 patients with simple subaortic membrane resection) and a group B (35 patients with subaortic membrane and muscle resection or modified Konno procedure).Results Two (2.67%) patients died in hospital. There was one late death in the group B. The average preoperative and postoperative pressure gradient of all patients was 69.96±42.02 mm Hg and 7.44±12.45 mm Hg, respectively. All patients were followed up for 51 (12, 120) months. Pressure gradient at follow-up in the group A and the group B was 8.83±14.52 mm Hg and 5.86±9.53 mm Hg, respectively with no statistical difference (P=0.294). Four patients in the group A and 2 patients in the group B needed reintervention. However, there was no statistical difference in the long-term reintervention rate between the two groups (P=0.480).Conclusion For the different degree of lesions in the left ventricular outflow tract, our management strategy is feasible. Although there is no statistical difference between two the groups in the long-term reintervention rate after simple valvular membrane resection, prolonged follow-up is necessary to examine the long-term outcomes of different surgical techniques.

Citation： ZHANG Benqing, MA Kai, ZHANG Sen, YAN Jun, HUA Zhongdong, LI Shoujun. Mid- and long-term results of different techniques for subaortic stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 233-237. doi: 10.7507/1007-4848.202007092 Copy

1.	Laredo M, Khraiche D, Raisky O, et al. Long-term results of the modified Konno procedure in high-risk children with obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg, 2018, 156(6): 2285-2294.
2.	Chen L, Schelegle A, Choi J, et al. What lurks beneath: A subaortic membrane. Am J Med, 2019, 132(6): 698-700.
3.	Pickard SS, Geva A, Gauvreau K, et al. Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children. Heart, 2015, 101(19): 1547-1553.
4.	Laguna G, Blanco M, Carrascal Y. Subaortic stenosis by accessory mitral tissue: Failure of embryonic positioning? J Thorac Cardiovasc Surg, 2018, 156(2): 777-779.
5.	Liu H, Gao B, Sun Q, et al. Surgical strategies and outcomes of congenital supravalvular aortic stenosis. J Card Surg, 2017, 32(10): 652-658.
6.	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.
7.	Dorobantu DM, Sharabiani MT, Martin RP, et al. Surgery for simple and complex subaortic stenosis in children and young adults: Results from a prospective, procedure-based national database. J Thorac Cardiovasc Surg, 2014, 148(6): 2618-2626.
8.	de Agustin JA, Rodrigo JL, Marcos-Alberca P, et al. Subaortic membrane coexisting with systolic anterior motion of the mitral valve. Int J Cardiol, 2015, 185: 157-158.
9.	Donald JS, Naimo PS, d'Udekem Y, et al. Outcomes of subaortic obstruction resection in children. Heart Lung Circ, 2017, 26(2): 179-186.
10.	Dearani JA. Modified Konno instead of myectomy: Another tool in the box? J Thorac Cardiovasc Surg, 2018, 156(6): 2295-2296.
11.	Stauber A, Wey C, Greutmann M, et al. Left ventricular outflow tract obstruction and its impact on systolic ventricular function and exercise capacity in adults with a subaortic right ventricle. Int J Cardiol, 2017, 244: 139-142.
12.	Mashari A, Mahmood F. Fixed versus dynamic left ventricular outflow tract obstruction: Res ipsa loquitur. J Thorac Cardiovasc Surg, 2016, 151(3): 885-886.
13.	Sarioğlu T, Arnaz A, Saygili A. Accessory miniature mitral valve causing subaortic obstruction. Ann Thorac Surg, 2015, 99(5): 1868-1869.
14.	Backer CL, Eltayeb O, Mongé MC, et al. Modified single patch: Are we still worried about subaortic stenosis? Ann Thorac Surg, 2015, 99(5): 1671-1675.
15.	Valeske K, Huber C, Mueller M, et al. The dilemma of subaortic stenosis—A single center experience of 15 years with a review of the literature. Thorac Cardiovasc Surg, 2011, 59(5): 293-297.
16.	Tanaka Y, Miyamoto T, Minami K, et al. Useful surgical instruments for the resection of subaortic stenosis. J Thorac Cardiovasc Surg, 2015, 150(2): 421-422.
17.	Tefera E, Gedlu E, Bezabih A, et al. Outcome in children operated for membranous subaortic stenosis: Membrane resection plus aggressive septal myectomy versus membrane resection alone. World J Pediatr Congenit Heart Surg, 2015, 6(3): 424-428.

1. Laredo M, Khraiche D, Raisky O, et al. Long-term results of the modified Konno procedure in high-risk children with obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg, 2018, 156(6): 2285-2294.
2. Chen L, Schelegle A, Choi J, et al. What lurks beneath: A subaortic membrane. Am J Med, 2019, 132(6): 698-700.
3. Pickard SS, Geva A, Gauvreau K, et al. Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children. Heart, 2015, 101(19): 1547-1553.
4. Laguna G, Blanco M, Carrascal Y. Subaortic stenosis by accessory mitral tissue: Failure of embryonic positioning? J Thorac Cardiovasc Surg, 2018, 156(2): 777-779.
5. Liu H, Gao B, Sun Q, et al. Surgical strategies and outcomes of congenital supravalvular aortic stenosis. J Card Surg, 2017, 32(10): 652-658.
6. 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.
7. Dorobantu DM, Sharabiani MT, Martin RP, et al. Surgery for simple and complex subaortic stenosis in children and young adults: Results from a prospective, procedure-based national database. J Thorac Cardiovasc Surg, 2014, 148(6): 2618-2626.
8. de Agustin JA, Rodrigo JL, Marcos-Alberca P, et al. Subaortic membrane coexisting with systolic anterior motion of the mitral valve. Int J Cardiol, 2015, 185: 157-158.
9. Donald JS, Naimo PS, d'Udekem Y, et al. Outcomes of subaortic obstruction resection in children. Heart Lung Circ, 2017, 26(2): 179-186.
10. Dearani JA. Modified Konno instead of myectomy: Another tool in the box? J Thorac Cardiovasc Surg, 2018, 156(6): 2295-2296.
11. Stauber A, Wey C, Greutmann M, et al. Left ventricular outflow tract obstruction and its impact on systolic ventricular function and exercise capacity in adults with a subaortic right ventricle. Int J Cardiol, 2017, 244: 139-142.
12. Mashari A, Mahmood F. Fixed versus dynamic left ventricular outflow tract obstruction: Res ipsa loquitur. J Thorac Cardiovasc Surg, 2016, 151(3): 885-886.
13. Sarioğlu T, Arnaz A, Saygili A. Accessory miniature mitral valve causing subaortic obstruction. Ann Thorac Surg, 2015, 99(5): 1868-1869.
14. Backer CL, Eltayeb O, Mongé MC, et al. Modified single patch: Are we still worried about subaortic stenosis? Ann Thorac Surg, 2015, 99(5): 1671-1675.
15. Valeske K, Huber C, Mueller M, et al. The dilemma of subaortic stenosis—A single center experience of 15 years with a review of the literature. Thorac Cardiovasc Surg, 2011, 59(5): 293-297.
16. Tanaka Y, Miyamoto T, Minami K, et al. Useful surgical instruments for the resection of subaortic stenosis. J Thorac Cardiovasc Surg, 2015, 150(2): 421-422.
17. Tefera E, Gedlu E, Bezabih A, et al. Outcome in children operated for membranous subaortic stenosis: Membrane resection plus aggressive septal myectomy versus membrane resection alone. World J Pediatr Congenit Heart Surg, 2015, 6(3): 424-428.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mid- and long-term results of different techniques for subaortic stenosis

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