MANAGEMENT OF FIXED SUBAORTIC STENOSIS - A RETROSPECTIVE STUDY OF 57 CASES

Although recommended by several investigators, the benefit of early su rgery in patients with fixed subaortic stenosis has not been proved. F indings were reviewed of 57 patients with isolated fixed subaortic ste nosis, including 27 surgically treated patients, with special emphasis on the occurrence of aortic regurgitation during a mean follow-up per iod of 6.7 years. The number of patients with aortic regurgitation inc reased preoperatively in the total group (23% at diagnosis to 54% afte r 3.7 years of follow-up). The prevalence of aortic regurgitation in t he 27 surgically treated patients was higher (81%) than that in the no nsurgically treated group but remained unchanged after a mean postoper ative period of 4.7 years. In all patients but one, aortic regurgitati on remained of minor hemodynamic significance. One patient died during follow-up. After surgery, 15 patients (55%) showed a relapse; 11 rede veloped a subvalvular pressure gradient > 30 mm Hg and discrete subval vular ridges (range 6 months to 24 years after surgery, mean 7 years). In those patients with fixed subaortic stenosis, follow-up did not re veal any benefit from early surgery. The unpredictable course and some times very severe progression of this disease make frequent and carefu l follow-up necessary.