TRANSAORTIC RESECTION OF THE SUBAORTIC MEMBRANE - TREATMENT FOR SUBVALVULAR AORTIC-STENOSIS

In an attempt to better understand congenital subaortic stenosis, we r eviewed 19 consecutive pediatric patients undergoing surgery for this problem between 1973 and 1984. Preoperative cardiac catheterization de monstrated subvalvular stenosis in all patients and associated anomali es in 11 patients. All patients underwent transaortic resection of the subaortic membrane. Five patients underwent concurrent additional car diac procedures. An 8-month-old infant with multiple cardiac anomalies was the only operative mortality. Follow-up extended to 16 years, wit h a mean of 6.9 years. In five symptomatic patients, cardiac catheteri zation revealed a mean systolic pressure gradient of 33.0 +/- 31.94 mm Hg 24.7 months (mean) after surgery. Two of these patients (11.1 perc ent of survivors) required reoperation. Twelve of the remaining 13 asy mptomatic patients underwent echocardiographic follow-up, and 4 were f ound to have recurrent stenosis with 1 requiring surgery (5.6 percent of survivors). Our experience shows that transaortic resection of the subaortic membrane is an acceptable treatment for subvalvular aortic s tenosis, but is associated with a high incidence of recurrence requiri ng reoperation (3 of 18 or 16.7 percent). Consequently, it is reasonab le to consider the role of alternative therapies which may help preven t recurrence in selected cases.