Management of fixed subaortic stenosis: A retrospective study of 57 cases

• Published in: Journal of the American College of Cardiology Vol. 19; no. 5; pp. 1013 - 1017
• Main Authors: de Vries, Arie G., Hess, John, Witsenburg, Maarten, Frohn-Mulder, Ingrid M.E., Bogers, Ad J.J.C., Bos, Egbert
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.1992; Elsevier Science
• Subjects: Adolescent; Aortic Stenosis, Subvalvular - complications; Aortic Stenosis, Subvalvular - surgery; Aortic Valve Insufficiency - etiology; Biological and medical sciences; Cardiology. Vascular system; Cardiomegaly - etiology; Child; Child, Preschool; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Postoperative Complications; Recurrence; Retrospective Studies; Time Factors; Treatment Outcome; Ventricular Outflow Obstruction - etiology; Human; Treatment; Cardiac valvular disease; Follow up study; Stenosis; Cardiovascular disease; Subvalvular; Aortic valve; Left ventricle
• ISSN: 0735-1097
• DOI: 10.1016/0735-1097(92)90286-V

Although recommended by several investigators, the benefit of early surgery in patients with fixed subaortic stenosis has not been proved. Findings were reviewed of 57 patients with isolated fixed subaortic stenosis, including 27 surgically treated patients, with special emphasis on the occurrence of aortic regurgitation during a mean follow-up period of 6.7 years. The number of patients with aortic regurgitation increased preoperatively in the total group (23% at diagnosis to 54% after 3.7 years of follow-up). The prevalence of aortic regurgitation in the 27 surgically treated patients was higher (81%) than that in the nonsurgically treated group but remained unchanged after a mean postoperative period of 4.7 years. In all patients but one, aortic regurgitation remained of minor hemodynamic significance. One patient died during follow-up. After surgery, 15 patients (55%) showed a relapse; 11 redeveloped a subvalvular pressure gradient >39 mm Hg and discrete subvalvular ridges (range 6 months to 24 years after surgery, mean 7 years). In those patients with fixed subaortic stenosis, follow-up did not reveal any benefit from early surgery. The unpredictable course and sometimes very severe progression of this disease make frequent and careful follow-up necessary.