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Subvalvar aortic stenosis: timing of operation
E C Douville1, R M Sade, F A Crawford
1Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston 29425.
The Annals of Thoracic Surgery
|July 1, 1990
Summary
Resection of subaortic stenosis is a safe and effective treatment for left ventricular outflow tract obstruction. Early surgical intervention is recommended, regardless of gradient severity or symptoms, for optimal outcomes.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Subvalvar aortic stenosis presents risks including left ventricular outflow tract obstruction, aortic insufficiency, and infective endocarditis.
- Congenital cardiac anomalies are frequently associated with subvalvar aortic stenosis.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical resection for subvalvar aortic stenosis.
- To assess the impact of surgery on left ventricular outflow tract obstruction and aortic valve function.
Main Methods:
- Retrospective review of 36 surgical patients undergoing 39 operations for subaortic stenosis.
- Analysis of pre- and post-operative left ventricular outflow tract systolic pressure gradients and aortic valve function.
Main Results:
- Surgical resection significantly reduced the mean left ventricular outflow tract systolic pressure gradient (64 mmHg to 9 mmHg, p < 0.001).
- Aortic insufficiency was present in 63% of patients preoperatively, with minimal changes postoperatively.
- One perioperative death occurred in a patient with complex congenital heart disease (Tetralogy of Fallot).
Conclusions:
- Surgical resection of subvalvar aortic stenosis is a safe and effective procedure.
- Early surgical intervention at diagnosis, irrespective of gradient or symptoms, is a viable therapeutic option.