Surgery for membranous subaortic stenosis. Long-term follow-up.
From 1958 to 1992, 105 patients were operated for discrete (or membranous) subaortic stenosis (DSAS). Our surgical techniques changed during this period. Before 1980 DSAS was removed by a sharp excision leaving the part on the mitral valve untouched (n = 58). After 1980 blunt dissection was used to enucleate DSAS completely (n = 47). The operation for DSAS was combined with aortic valve replacement (AVR) in 7 instances. Follow-up with recent echo-Doppler studies was complete in 100 patients. Recurring or persisting DSAS led to reoperation in 17 patients. Sixteen of them had had sharp, incomplete resections. One patient from the group of complete blunt enucleations was reoperated on twice. The interval between the first operation and the first reoperation averaged 9.7 years (range: 1-33 years). Nine reoperated patients had AVR. The risk factors for AVR were older age at first operation or late reoperation. In our early experience five patients died after operation. Another three patients died following one or more reoperations. Blunt dissection never led to complete AV block. It follows the anatomical cleavage planes and always allowed for complete and safe removal of DSAS. Although the follow-up is shorter, blunt enucleation thus far has had a lower incidence of reoperation.
Department of Cardiothoracic Surgery, University Hospital Leiden, The Netherlands.
M G
MG
Hazekamp
M
M
Frank
R
R
Hardjowijono
J M
JM
Quaegebeur
J
J
Ottenkamp
H A
HA
Huysmans
D000293:Adolescent; D000328:Adult; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors