title: Subaortic Area at Risk for Development of Obstruction After Surgical Repair of Atrioventricular Septal Defect: Myth or Reality?
abstract: BACKGROUND
  Morphology of the left ventricular outflow tract (LVOT) in atrioventricular septal defects (AVSDs) has been reported to be at risk for development of obstruction. The purpose of the present study was to identify the incidence, the risk factors, and the surgical outcomes of subaortic stenosis in repaired AVSDs.
  
  
  METHODS
  Records of 427 consecutive patients who underwent anatomical repair for all types of AVSDs from January 2000 to December 2012 were reviewed. Outcomes, independent risk factors, reoperation, and death were analyzed.
  
  
  RESULTS
  In a median follow-up of five years (range: 17 months-11.8 years), eight patients required nine reoperations for subaortic stenosis. Study group (n = 11) included three additional patients for whom repair was performed in a different institution. Median delay for reoperation was 11.9 years (range: 1.3-19.4 years). Surgical relief of subaortic stenosis was obtained by means of the enlargement of the LVOT: resection of fibrous structures in all reoperated patients and associated with septal myectomy in four. Two patients required a modified Konno procedure. Five reoperations were associated with left atrioventricular valve repair or replacement. Statistical analysis didn't reveal any morphologic or demographic risk factors. No early or late death occurred.
  
  
  CONCLUSIONS
  The development of subaortic stenosis after repair of AVSD remains a rare complication in midterm follow-up (incidence: 1.9%). The performance of preventive gesture during repair seemed to be unjustified. The surgical management of this reoperation consists of a simple and safe procedure.
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France margaux.pontailler@wanadoo.fr.
authors.forename: Margaux
authors.initials: M
authors.lastname: Pontailler
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: André
authors.initials: A
authors.lastname: Capderou
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lebret
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Vergnat
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ly
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Régine
authors.initials: R
authors.lastname: Roussin
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
authors.forename: Emré
authors.initials: E
authors.lastname: Belli
mesh_terms: D001024:Aortic Valve Stenosis / Q000209:etiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006343:Heart Septal Defects / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Konno operation; atrioventricular septal defect (AVSD); reoperation; restenosis (subaortic)