title: The surgical history, management, and outcomes of subaortic stenosis in adults.
abstract: BACKGROUND
  Subaortic stenosis (SAS) is a curtain of tissue involving the subaortic region, the aortic and mitral valves, the septum, and the fibrous trigones. Little is known of its course or the outcomes of its surgical management in adults.
  
  
  METHODS
  We reviewed our experience of the surgical management of SAS in adults from 1999 to 2010. We divided patients into three groups: (1) those presenting for first-time SAS resection (6 patients, 4 male, median age of 46.9 ± 17 years, mean follow-up of 5 ± 2.7 years); (2) those requiring redo resection of SAS without organic aortic valve dysfunction (8 patients, 3 male, median age of 25.3 ± 5 years, mean follow-up of 8 ± 3.08 years); and (3) those with SAS and aortic valve dysfunction (8 patients, 4 males, median age of 34.8 ± 12 years, mean follow-up of 4.5 ± 2.5 years; 5 had previous SAS surgery).
  
  
  RESULTS
  Patients underwent extensive excision of the SAS, release of the fibrous trigones, and a septal myectomy if required. There was 1 early death in group 2 and 1 in group 3. In group 3, 1 patient underwent the Ross procedure and 7 patients had mechanical valve implantation. No patient required permanent pacemaker implantation. Overall follow-up was 3.3 ± 3 years (range, 6 months to 10 years). The preoperative left ventricular outflow tract gradient ranged from 40 to 120 mm Hg, and the postoperative left ventricular outflow tract gradient ranged from 0 to 16 mm Hg. At latest follow-up, no patient in groups 1 or 2 had greater than mild native aortic regurgitation.
  
  
  CONCLUSIONS
  Subaortic stenosis resection in adults can successfully relieve left ventricular outflow tract obstruction, with low mortality. The complexity of SAS increases with time; therefore a longer duration of follow-up is needed to further validate our conclusions.
authors.affiliation: Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Martin
authors.initials: M
authors.lastname: Kostolny
authors.forename: Tain-Yen
authors.initials: TY
authors.lastname: Hsia
authors.forename: Carin
authors.initials: C
authors.lastname: Van Doorn
authors.forename: Fiona
authors.initials: F
authors.lastname: Walker
authors.forename: Shay
authors.initials: S
authors.lastname: Cullen
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
authors.forename: Victor T
authors.initials: VT
authors.lastname: Tsang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001020:Aortic Stenosis, Subvalvular / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000601:surgery*; D055815:Young Adult