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Subaortic membrane excision: mid-term results
S Talwar1, A K Bisoi, R Sharma
1Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Background:
Subaortic membrane (SAM) is a form of fixed subaortic obstruction in which a fibrous membrane is located below the aortic valve.
Aim:
To determine the role of surgical treatment for patients with a discrete SAM.
Patients And Methods:
The hospital records of 45 patients (age range: 2-23 years; median 8 years) undergoing surgery for SAM between 1990 and 1998 at the All India Institute of Medical Sciences, New Delhi, India, were analysed. Preoperative echocardiographically calculated gradients across the left ventricular outflow tract ranged from 50 to 154 mmHg (mean: 86.5 +/- 33.2 mmHg). Nine patients had trivial aortic regurgitation (AR), 10 had mild AR and five had moderate-severe AR. The left ventricular ejection fraction (LVEF) ranged from 20 to 68% (mean 48 +/- 15%). Nineteen patients had significant left ventricular dysfunction (LVEF <50%). Transaortic resection of SAM was done in all patients along with excision of a wedge-shaped segment of septal muscle underlying the membrane.
Results:
There were no early or late postoperative deaths. On follow up (up to 113 months), only four patients had gradients >30 mmHg. LVEF improved to 45-70% (mean 58 +/- 7.7%). AR reduced to mild in four patients and trivial in four patients, and did not progress further.
Conclusion:
Resection of SAM carries long-term benefits. Routine septal myectomy appears to be associated with a low risk of recurrence.
Insights
Surgical resection of subaortic membrane (SAM) offers long-term benefits for patients with this fixed subaortic obstruction. Combining SAM resection with septal myectomy shows a low recurrence rate and improves heart function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pediatric Cardiology
Background:
- Subaortic membrane (SAM) is a congenital heart defect causing fixed subaortic obstruction.
- It involves a fibrous membrane below the aortic valve, impeding blood flow from the left ventricle.
Purpose of the Study:
- To evaluate the effectiveness and long-term outcomes of surgical treatment for discrete subaortic membrane.
- To assess the role of concomitant septal myectomy in preventing recurrence.
Main Methods:
- Retrospective analysis of 45 patients (aged 2-23 years) who underwent transaortic SAM resection with septal myectomy.
- Preoperative assessment included echocardiography to measure left ventricular outflow tract gradients and evaluate aortic regurgitation (AR) and ejection fraction (LVEF).
Main Results:
- No early or late deaths occurred post-surgery.
- Follow-up showed significant improvement in LVEF (mean 58%) and reduction in AR.
- Only four patients had residual gradients >30 mmHg, indicating successful obstruction relief.
Conclusions:
- Surgical resection of SAM provides durable, long-term benefits.
- Routine septal myectomy is associated with a low risk of SAM recurrence, improving patient outcomes.
