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The Dilemma of Subaortic Stenosis - A Single Center Experience of 15 Years with a Review of the Literature.
MedLine Citation:
PMID:  21544788     Owner:  NLM     Status:  Publisher    
OBJECTIVE: The term "subaortic stenosis" includes a variety of obstructions of the left ventricular outflow tract (LVOT), ranging from a short (discrete) subvalvular membrane to long, tunnel-like narrowing. An association with other congenital lesions is frequent. We reviewed the reported literature and describe our results, analyzing the nomenclature of and risk factors for restenosis after surgical treatment. METHODS: From 1994 to 2009, 81 children (53 males, 28 females; median age: 57 months, range [ R]: 5-204) underwent surgical relief of a subaortic stenosis. Patients were divided, according to pathology, into short segment (group A, n = 42) and complex obstructions (group B, n = 39), with the latter including long segment stenosis and/or associated anomalies such as aortic coarctation, interrupted aortic arch or Shone's complex. RESULTS: Surgery resulted in a significant reduction of the gradient between the left ventricle and the aorta in both groups (Δ P group A: 51 ± 28 mmHg, group B: 46 ± 25 mmHg). There was no operative mortality. One patient died in the early postoperative period due to pericardial tamponade. Median follow-up was 90 months ( R = 0.5-187). Twenty-five (31 %) patients required reoperation because of recurrent stenosis after a median of 43 months ( R = 0.5-128). Seven (16 %) patients belonging to group A developed restenosis, and 18 (46 %) in group B. Freedom from reoperation for all patients was 60 % after 10 years. 10 (40 %) of the patients of group B were ultimately treated with a Ross-Konno reconstruction of the LVOT. CONCLUSION: Despite adequate surgical resection, recurrence of subaortic stenosis within several years after initial surgical treatment is frequent, especially in patients with complex lesions. In cases requiring reoperation, the surgical therapy is often extensive, and even includes Ross-Konno reconstruction of the LVOT.
K Valeske; C Huber; M Mueller; A Böning; N Hijjeh; D Schranz; H Akintuerk
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-3
Journal Detail:
Title:  The Thoracic and cardiovascular surgeon     Volume:  -     ISSN:  1439-1902     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903387     Medline TA:  Thorac Cardiovasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© Georg Thieme Verlag KG Stuttgart · New York.
Department of Pediatric Cardiac Surgery, Children's Heart Center, Giessen, Germany.
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