Abstract
Data concerning 17 consecutive patients with discrete subaortic stenosis are recorded. Twelve patients underwent operative resection of the obstructing lesion. Of these all except one were symptomatic and all had electrocardiographic evidence of left ventricular hypertrophy or left ventricular hypertrophy with strain. They had a peak resting systolic left ventricular outflow tract gradient of greater than 50 mmHg as predicted from the combined cuff measurement of systolic blood pressure and the echocardiographically estimated left ventricular systolic pressure and/or as determined by cardiac catheterisation. The outflow tract gradient as predicted from M-mode echocardiography and peak systolic pressure showed close correlation with that measured at cardiac catheterisation or operation. During the postoperative follow-up from one month to 11 years, of 11 patients, one patient required a further operation for recurrence of the obstruction four years after the initial operation. All patients are now asymptomatic. Five patients have not had an operation. The left ventricular outflow tract gradient as assessed at the time of cardiac catheterisation was greater than 50 mmHg. One patient has been lost to follow-up. The remaining four have been followed from four to eight years and have remained asymptomatic and the electrocardiograms have remained unchanged. Careful follow-up of all patients is essential with continuing clinical assessment, electrocardiograms, M-mode and two-dimensional echocardiograms, and if necessary cardiac catheterisation. Prophylaxis against bacterial endocarditis is also essential.
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- Berry T. E., Aziz K. U., Paul M. H. Echocardiographic assessment of discrete subaortic stenosis in childhood. Am J Cardiol. 1979 May;43(5):957–961. doi: 10.1016/0002-9149(79)90359-x. [DOI] [PubMed] [Google Scholar]
- Block P. C., Powell W. J., Jr, Dinsmore R. E., Goldblatt A. Coexistent fixed congenital and idiopathic hypertrophic subaortic stenosis. Am J Cardiol. 1973 Apr;31(4):523–526. doi: 10.1016/0002-9149(73)90306-8. [DOI] [PubMed] [Google Scholar]
- Candell-Riera J., del Castillo H. G., Rius J. Aortic root dissection. Another cause of early systolic closure of the aortic valve. Br Heart J. 1980 May;43(5):579–581. doi: 10.1136/hrt.43.5.579. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cassel G. A., Benjamin J. D., Lakier J. B. Subendocardial ischaemia in patients with discrete subvalvar aortic stenosis. Br Heart J. 1978 Apr;40(4):388–392. doi: 10.1136/hrt.40.4.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Champsaur G., Trusler G. A., Mustard W. T. Congenital discrete subvalvar aortic stenosis. Surgical experience and long-term follow-up in 20 paediatric patients. Br Heart J. 1973 Apr;35(4):443–446. doi: 10.1136/hrt.35.4.443. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Davis R. H., Feigenbaum H., Chang S., Konecke L. L., Dillon J. C. Echocardiographic manifestations of discrete subaortic stenosis. Am J Cardiol. 1974 Feb;33(2):277–280. doi: 10.1016/0002-9149(74)90289-6. [DOI] [PubMed] [Google Scholar]
- Gewitz M. H., Werner J. C., Kleinman C. S., Hellenbrand W. E., Talner N. S. Role of echocardiography in aortic stenosis: pre- and postoperative studies. Am J Cardiol. 1979 Jan;43(1):67–73. doi: 10.1016/0002-9149(79)90046-8. [DOI] [PubMed] [Google Scholar]
- Glanz S., Hellenbrand W. E., Berman M. A., Talner N. S. Echocardiographic assessment of the severity of aortic stenosis in children and adolescents. Am J Cardiol. 1976 Nov 4;38(5):620–625. doi: 10.1016/s0002-9149(76)80012-4. [DOI] [PubMed] [Google Scholar]
- Katz N. M., Buckley M. J., Liberthson R. R. Discrete membranous subaortic stenosis. Report of 31 patients, review of the literature, and delineation of management. Circulation. 1977 Dec;56(6):1034–1038. doi: 10.1161/01.cir.56.6.1034. [DOI] [PubMed] [Google Scholar]
- Kelly D. T., Wulfsberg E., Rowe R. D. Discrete subaortic stenosis. Circulation. 1972 Aug;46(2):309–322. doi: 10.1161/01.cir.46.2.309. [DOI] [PubMed] [Google Scholar]
- Krajcer Z., Orzan F., Pechacek L. W., Garcia E., Leachman R. D. Early systolic closure of the aortic valve in patients with hypertrophic subaortic stenosis and discrete subaortic stenosis. Correlation with preoperative and postoperative hemodynamics. Am J Cardiol. 1978 May 1;41(5):823–829. doi: 10.1016/0002-9149(78)90720-8. [DOI] [PubMed] [Google Scholar]
- Kronzon I., Schloss M., Danilowicz D., Singh A. Fixed membranous subaortic stenosis. Chest. 1975 Apr;67(4):473–474. doi: 10.1378/chest.67.4.473. [DOI] [PubMed] [Google Scholar]
- Newfeld E. A., Muster A. J., Paul M. H., Idriss F. S., Riker W. L. Discrete subvalvular aortic stenosis in childhood. Study of 51 patients. Am J Cardiol. 1976 Jul;38(1):53–61. doi: 10.1016/0002-9149(76)90062-x. [DOI] [PubMed] [Google Scholar]
- Popp R. L., Silverman J. F., French J. W., Stinson E. B., Harrison D. C. Echocardiographic findings in discrete subvalvular aortic stenosis. Circulation. 1974 Feb;49(2):226–231. doi: 10.1161/01.cir.49.2.226. [DOI] [PubMed] [Google Scholar]
- Shariatzadeh A. N., King H., Girod D., Shumacker H. B., Jr Discrete subaortic stenosis. A report of 20 cases. J Thorac Cardiovasc Surg. 1972 Feb;63(2):258–261. [PubMed] [Google Scholar]
- Somerville J., Stone S., Ross D. Fate of patients with fixed subaortic stenosis after surgical removal. Br Heart J. 1980 Jun;43(6):629–647. doi: 10.1136/hrt.43.6.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sung C. S., Price E. C., Cooley D. A. Discrete subaortic stenosis in adults. Am J Cardiol. 1978 Aug;42(2):283–290. doi: 10.1016/0002-9149(78)90912-8. [DOI] [PubMed] [Google Scholar]
- Weyman A. E., Feigenbaum H., Hurwitz R. A., Girod D. A., Dillon J. C., Chang S. Cross-sectional echocardiography in evaluating patients with discrete subaortic stenosis. Am J Cardiol. 1976 Mar 4;37(3):358–365. doi: 10.1016/0002-9149(76)90284-8. [DOI] [PubMed] [Google Scholar]




