title: Outcome in Children Operated for Membranous Subaortic Stenosis: Membrane Resection Plus Aggressive Septal Myectomy Versus Membrane Resection Alone.
abstract: BACKGROUND
  The optimal surgical procedure for treatment of fibromembranous subaortic stenosis has been a subject of debate. We report our experience with patients treated for membranous subaortic stenosis using membrane resection alone and membrane resection plus aggressive septal myectomy.
  
  
  METHODS
  Patients followed in the pediatric cardiology clinic of a university hospital, who had undergone surgery for subaortic stenosis between 2002 and 2013 were reviewed. Recurrence of subaortic membrane, residual left ventricular outflow gradient, and aortic valve function were analyzed.
  
  
  RESULTS
  Forty-six patients underwent surgery for subaortic membrane. Of these, 19 had membrane resection plus aggressive septal myectomy, while 27 had membrane resection alone. Mean age at surgery for the membrane resection group was 7.7 ± 3.9 years and 10.9 ± 3.6 years for the membrane resection plus aggressive myectomy group. Preoperative subaortic gradient for the membrane resection group was 75.5 ± 26.7 mm Hg and 103.2 ± 39.7 mm Hg for the membrane resection plus aggressive myectomy group. The mean follow-up left ventricular outflow tract gradient was 42.3 ± 31.3 mm Hg in the membrane resection group, while it was 11.6 ± 6.3 mm Hg in the aggressive septal myectomy group. Nine patients from the membrane resection group had significant regrowth of the subaortic membrane during the follow-up period, while none of the aggressive septal myectomy group had detectable membrane on echocardiography. Seven of the nine patients with recurrence of the subaortic membrane underwent subsequent membrane resection plus aggressive septal myectomy. Intraoperative finding in all these redo cases was recurrence (growth) of a subaortic membrane.
  
  
  CONCLUSIONS
  Aggressive septal myectomy offers less chance of recurrence, freedom from reoperation, and an improved aortic valve function. This is especially important in sub-Saharan settings where a chance of getting a second surgery is unpredictable.
authors.affiliation: Department of Pediatrics and Child Health, Cardiology Division, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia endalet2008@gmail.com.
authors.forename: Endale
authors.initials: E
authors.lastname: Tefera
authors.affiliation: Department of Pediatrics and Child Health, Cardiology Division, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Etsegenet
authors.initials: E
authors.lastname: Gedlu
authors.affiliation: Department of Surgery, Cardiothoracic Surgery Unit, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Abebe
authors.initials: A
authors.lastname: Bezabih
authors.affiliation: Department of Pediatrics and Child Health, Cardiology Division, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Tamirat
authors.initials: T
authors.lastname: Moges
authors.affiliation: Department of Cardiovascular Surgery, Ramon y Cajal University Hospital, Madrid, Spain.
authors.forename: Tomasa
authors.initials: T
authors.lastname: Centella
authors.affiliation: Department of Cardiothoracic Surgery, Pediatric Cardiac Surgery Unit, Niguarda Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Marianeschi
authors.affiliation: Department of Surgery, Cardiothoracic Surgery Unit, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Berhanu
authors.initials: B
authors.lastname: Nega
authors.affiliation: Congenital Cardiac Unit, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom.
authors.forename: Carin
authors.initials: C
authors.lastname: van Doorn
authors.affiliation: Department of Cardiothoracic Surgery, Wolfson Medical Center, Holon, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Sasson
authors.affiliation: Department of Surgery, Pediatric and Adult Congenital Heart Surgery Division, University of Arizona, Tucson, AZ, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Teodori
mesh_terms: D000293:Adolescent; D001022:Aortic Valve Insufficiency / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D021922:Discrete Subaortic Stenosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: aggressive septal myectomy; aortic valve function; membrane resection; residual left ventricular outflow gradient; subaortic membrane