Surgical results in subaortic stenosis.
Since 1965, 46 patients aged 4 to 42 years, underwent cardiac surgery for subaortic stenosis. Resection of the subvalvar obstruction without myomectomy was performed in all cases. Three patients died during the operation, another one after 6 months due to infective endocarditis and one more suddenly 11 years after treatment. One patient was lost to follow-up but 41 were available after at least 1 year of follow-up. Before surgery, 21 cases were in NYHA class I, 17 in class II and 8 in class III. One year after surgery 36 were in class I, 4 in class II and only one in class III. Actuarial survival rate was 91% from 1 to 12 years and 79% from 13 to 18 years. Event-free survival was 45% up to 18 years. The mean preoperative peak systolic gradient was 93.15 +/- 35.57 mm Hg. The first postoperative peak systolic gradient was 21.61 +/- 17.91 mm Hg (P = 0.001). Cases with adverse postoperative events such as aortic regurgitation (13 cases), restenosis (13 cases), death (2 cases) and infective endocarditis (2 cases) had a mean peak systolic gradient of 55.78 +/- 35.97 mm Hg, while in the event-free patients the gradient was 14.61 +/- 13.34 mm Hg (P = 0.001). Recurrent obstruction was observed in seven patients and an increase in the residual gradient in six. The initial mean postoperative peak systolic gradient in these patients had been 18.23 +/- 17.32 mm Hg and the second postoperative cardiac catheterisation showed a mean gradient of 59.23 +/- 37.78 mm Hg (P = 0.001). We conclude that long-term follow-up following removal of subaortic stenosis is mandatory in order to detect and treat adverse events.
D000293:Adolescent; D000328:Adult; D001020:Aortic Stenosis, Subvalvular / Q000175:diagnosis / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D008297:Male; D011183:Postoperative Complications / Q000401:mortality