title: The dilemma of subaortic stenosis--a single center experience of 15 years with a review of the literature.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatric Cardiac Surgery, Children's Heart Center, Giessen, Germany. klaus.valeske@chiru.med.uni-giessen.de
authors.forename: K
authors.initials: K
authors.lastname: Valeske
authors.forename: C
authors.initials: C
authors.lastname: Huber
authors.forename: M
authors.initials: M
authors.lastname: Mueller
authors.forename: A
authors.initials: A
authors.lastname: Böning
authors.forename: N
authors.initials: N
authors.lastname: Hijjeh
authors.forename: D
authors.initials: D
authors.lastname: Schranz
authors.forename: H
authors.initials: H
authors.lastname: Akintuerk
mesh_terms: D000293:Adolescent; D001020:Aortic Stenosis, Subvalvular / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D021922:Discrete Subaortic Stenosis / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D009626:Terminology as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*