Late Results After Resection of Fixed Subaortic Stenosis

Abstract

Resection of fixed subaortic stenosis was performed on 44 patients with median age 14 (range 2–61) years. Concomitant aortic valve pathology was present in 14 (32%) cases (congenital stenosis in 2, thick fibrotic cusps in 8 and incompetent cusps in 4) and other congenital cardiovascular malformations in eight (18%). There was no perioperative mortality. Of the six late deaths, three were due to non-cardiac causes. During follow-up (median 6, range 2–21 years), six reoperations were performed for residual or recurrent obstruction and/or aortic incompetence. Aortic valve replacement was required at two primary and four second operations. Actuarial 5-year and 10-year survival rates were 89% and 76%, respectively, and rates with freedom from cardiac death endocarditis and reoperation 83% and 64%. At follow-up evaluation two patients had significant aortic regurgitation and all survivors had a systolic ejection murmur. At Doppler echocardiography in 29 patients without reoperation, the median pressure difference in the left ventricular outflow tract was 10 (range 0–55) mmHg—in three cases≥30 mmHg. Careful follow-up is advisable after resection of fixed subaortic stenosis, because of the risk of residual or recurrent obstruction and of significant aortic valve incompetence.

Key Words:

• subaortic stenosis
• Doppler-echocardiography