Secondary subaortic stenosis following ventricular septal defect closure: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DONG Jie , DU Chuhao , DUAN Yabing , XU Haitao , SUN Yangxue , ZOU Mengxuan , LI Shoujun , YAN Jun ,  DONG Shuo

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

Corresponding author：

DONG Shuo, Email: leslie_dongshuo@126.com

Keywords：

Ventricular septal defect; subaortic stenosis; congenital heart disease; cardiac surgery

DOI：

10.7507/1007-4848.202210021

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the characteristics of children diagnosed with secondary subaortic stenosis after the surgical closure for ventricular septal defect and explore its potential mechanism. Methods We retrospectively collected patients aged from 0 to 18 years, who underwent ventricular septal defect closure and developed secondary subaortic stenosis, and subsequently received surgical repair from 2008 to 2019 in Fuwai Hospital. Their surgical details, morphological features of the subaortic stenosis, and the follow-up information were analyzed. Results Six patients, including 2 females and 4 males, underwent the primary ventricular septal defect closure at the median age of 9 months (ranging from 1 month to 3 years). After the first surgery, patients were diagnosed with secondary subaortic stenosis after 2.9 years (ranging from 1 to 137 months). Among them, 2 patients underwent the second surgery immediately after diagnosis, and the other 4 patients waited 1.2 years (ranging from 6 to 45 months) for the second surgery. The most common type of the secondary subaortic stenosis after ventricular septal defect closure was discrete membrane, which located underneath the aortic valve and circles as a ring. In some patients, subaortic membrane grew along with the ventricular septal defect closure patch. During the median follow-up of 8.1 years (ranging from 7.3 to 8.9 years) after the sencond surgery, all patients recovered well without any recurrence of left ventricular outflow tract obstruction. Conclusion Regular and persistent follow-up after ventricular septal defect closure combining with or without other cardiac malformation is the best way to diagnose left ventricular outflow tract obstruction in an early stage and stop the progression of aortic valve regurgitation.

Citation： DONG Jie, DU Chuhao, DUAN Yabing, XU Haitao, SUN Yangxue, ZOU Mengxuan, LI Shoujun, YAN Jun, DONG Shuo. Secondary subaortic stenosis following ventricular septal defect closure: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1446-1451. doi: 10.7507/1007-4848.202210021 Copy

1.	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.
2.	Cao Y, Fan X. Surgical repair of secondary subaortic stenosis in congenital heart disease without initial subaortic obstruction. Heart Surg Forum, 2022, 25(1): E108-E112.
3.	Zhang X, Wang W, Yan J, et al. Surgical treatment results of secondary tunnel-like subaortic stenosis after congenital heart disease operations: A 7-year, single-center experience in 25 patients. J Card Surg, 2020, 35(2): 335-340.
4.	Horta Mda G, Faria CA, Rezende DF, et al. Subaortic stenosis associated with perimembranous ventricular septal defect. Clinical follow-up of 36 patients. Arq Bras Cardiol, 2005, 84(2): 103-107.
5.	Otterstad JE, Erikssen J, Michelsen S, et al. Long-term follow-up in isolated ventricular septal defect considered too small to warrant operation. J Intern Med, 1990, 228(4): 305-309.
6.	Somerville J. Fixed subaortic stenosis: A frequently misunderstood lesion. Int J Cardiol 1985, 8: 145-148.
7.	Cicini MP, Giannico S, Marino B, et al. "Acquired" subvalvular aortic stenosis after repair of a ventricular septal defect. Chest, 1992, 101(1): 115-118.
8.	董硕, 闫军, 李守军. 先天性心脏病外科治疗中国专家共识(九): 主动脉瓣下狭窄. 中国胸心血管外科临床杂志, 2020, 27(10): 1113-1118.
9.	Cohen L, Bennani R, Hulin S, et al. Mitral valvar anomalies and discrete subaortic stenosis. Cardiol Young, 2002, 12(2): 138-146.
10.	罗丹东, 陈寄梅, 岑坚正, 等. 继发于先天性心脏病术后的主动脉瓣下狭窄手术矫治分析. 中国胸心血管外科临床杂志, 2013, 20(6): 623-627.
11.	许伟滨, 梁婷婷, 李虹, 等. 先天性心脏病术后患儿继发主动脉瓣下狭窄的原因及外科治疗效果分析. 岭南心血管病杂志, 2022, 28(3): 201-204,224.
12.	Van Praagh R, Corwin RD, Dahlquist EH, et al. Tetralogy of Fallot with severe left ventricular anomalous attachment of the mitral valve to the ventricular septum. Am J Cardiol, 1970, 26(1): 93-101.
13.	王栋, 吴永涛, 王执一, 等. 22例先天性心脏病术后主动脉瓣下狭窄的再次手术. 心肺血管病杂志, 2020, 39(5): 510-513.
14.	Vogel M, Smallhorn JF, Freedom RM, et al. An echocardiographic study of the association of ventricular septal defect and right ventricular muscle bundles with a fixed subaortic abnormality. Am J Cardiol, 1988, 61(10): 857-860.
15.	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.
16.	Cho YK, Oh SM, Joo JW, et al. Secondary subaortic stenosis after patch closure of subarterial ventricular septal defect. J Cardiovasc Ultrasound, 2010, 18(2): 52-54.
17.	Shem-Tov A, Schneeweiss A, Motro M, et al. Clinical presentation and natural history of mild discrete subaortic stenosis. Follow-up of 1-17 years. Circulation, 1982, 66(3): 509-512.

1. 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.
2. Cao Y, Fan X. Surgical repair of secondary subaortic stenosis in congenital heart disease without initial subaortic obstruction. Heart Surg Forum, 2022, 25(1): E108-E112.
3. Zhang X, Wang W, Yan J, et al. Surgical treatment results of secondary tunnel-like subaortic stenosis after congenital heart disease operations: A 7-year, single-center experience in 25 patients. J Card Surg, 2020, 35(2): 335-340.
4. Horta Mda G, Faria CA, Rezende DF, et al. Subaortic stenosis associated with perimembranous ventricular septal defect. Clinical follow-up of 36 patients. Arq Bras Cardiol, 2005, 84(2): 103-107.
5. Otterstad JE, Erikssen J, Michelsen S, et al. Long-term follow-up in isolated ventricular septal defect considered too small to warrant operation. J Intern Med, 1990, 228(4): 305-309.
6. Somerville J. Fixed subaortic stenosis: A frequently misunderstood lesion. Int J Cardiol 1985, 8: 145-148.
7. Cicini MP, Giannico S, Marino B, et al. "Acquired" subvalvular aortic stenosis after repair of a ventricular septal defect. Chest, 1992, 101(1): 115-118.
8. 董硕, 闫军, 李守军. 先天性心脏病外科治疗中国专家共识(九): 主动脉瓣下狭窄. 中国胸心血管外科临床杂志, 2020, 27(10): 1113-1118.
9. Cohen L, Bennani R, Hulin S, et al. Mitral valvar anomalies and discrete subaortic stenosis. Cardiol Young, 2002, 12(2): 138-146.
10. 罗丹东, 陈寄梅, 岑坚正, 等. 继发于先天性心脏病术后的主动脉瓣下狭窄手术矫治分析. 中国胸心血管外科临床杂志, 2013, 20(6): 623-627.
11. 许伟滨, 梁婷婷, 李虹, 等. 先天性心脏病术后患儿继发主动脉瓣下狭窄的原因及外科治疗效果分析. 岭南心血管病杂志, 2022, 28(3): 201-204,224.
12. Van Praagh R, Corwin RD, Dahlquist EH, et al. Tetralogy of Fallot with severe left ventricular anomalous attachment of the mitral valve to the ventricular septum. Am J Cardiol, 1970, 26(1): 93-101.
13. 王栋, 吴永涛, 王执一, 等. 22例先天性心脏病术后主动脉瓣下狭窄的再次手术. 心肺血管病杂志, 2020, 39(5): 510-513.
14. Vogel M, Smallhorn JF, Freedom RM, et al. An echocardiographic study of the association of ventricular septal defect and right ventricular muscle bundles with a fixed subaortic abnormality. Am J Cardiol, 1988, 61(10): 857-860.
15. 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.
16. Cho YK, Oh SM, Joo JW, et al. Secondary subaortic stenosis after patch closure of subarterial ventricular septal defect. J Cardiovasc Ultrasound, 2010, 18(2): 52-54.
17. Shem-Tov A, Schneeweiss A, Motro M, et al. Clinical presentation and natural history of mild discrete subaortic stenosis. Follow-up of 1-17 years. Circulation, 1982, 66(3): 509-512.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Secondary subaortic stenosis following ventricular septal defect closure: A retrospective study in a single center

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content