Outcome in Children Operated for Membranous Subaortic Stenosis

Author:

Tefera Endale1,Gedlu Etsegenet1,Bezabih Abebe2,Moges Tamirat1,Centella Tomasa3,Marianeschi Stefano4,Nega Berhanu2,van Doorn Carin5,Sasson Lior6,Teodori Michael7

Affiliation:

1. Department of Pediatrics and Child Health, Cardiology Division, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

2. Department of Surgery, Cardiothoracic Surgery Unit, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

3. Department of Cardiovascular Surgery, Ramon y Cajal University Hospital, Madrid, Spain

4. Department of Cardiothoracic Surgery, Pediatric Cardiac Surgery Unit, Niguarda Hospital, Milan, Italy

5. Congenital Cardiac Unit, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom

6. Department of Cardiothoracic Surgery, Wolfson Medical Center, Holon, Israel

7. Department of Surgery, Pediatric and Adult Congenital Heart Surgery Division, University of Arizona, Tucson, AZ, USA

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. Conclusion: 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.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Pediatrics, Perinatology and Child Health,Surgery

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