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Prevalence and associated risk factors for intervention in 313 children with subaortic stenosis

Tara Karamlou1, Rebecca Gurofsky, Alexandra Bojcevski

  • 1Division of Cardiovascular Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.

The Annals of Thoracic Surgery
|August 28, 2007
PubMed

Insights

Delaying subaortic resection in children with subaortic stenosis until the left ventricular (LV) gradient exceeds 30 mm Hg is recommended. Most children with lower LV gradients have stable disease, avoiding early intervention for subaortic stenosis.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Cardiovascular Surgery

Background:

  • Subaortic stenosis is a significant cause of left ventricular outflow tract obstruction in children.
  • Early intervention for subaortic stenosis is debated, with a 1994 protocol recommending early resection if the LV gradient exceeds 30 mm Hg.

Purpose of the Study:

  • To determine the prevalence of intervention for subaortic stenosis in children.
  • To identify factors associated with intervention and progression of the LV gradient.
  • To evaluate the longitudinal outcomes of the 1994 early resection protocol.

Main Methods:

  • Retrospective review of 313 children diagnosed with subaortic stenosis (1975-1998).
  • Cox proportional hazard models for intervention prevalence and factors.
  • Mixed models of serial echocardiographic data (933 studies) for LV gradient trends.

Main Results:

  • Freedom from initial resection was 40% at 16 years.
  • Higher initial LV gradient, larger aortic annulus z-score, smaller body surface area, and smaller mitral annulus z-score were associated with earlier resection.
  • Initial LV gradient >30 mm Hg, aortic valve thickening, and mitral valve attachment predicted faster LV gradient progression and worse aortic regurgitation.

Conclusions:

  • Subaortic resection should be delayed until the LV gradient exceeds 30 mm Hg.
  • Most children with initial LV gradients <30 mm Hg exhibit quiescent disease, supporting a conservative approach.
Abstract

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