Secondary subaortic stenosis in heart defects without any initial subaortic obstruction: a multifactorial postoperative event

Kalfa, David; Ghez, Olivier; Kreitmann, Bernard; Metras, Dominique
October 2007
European Journal of Cardio-Thoracic Surgery;Oct2007, Vol. 32 Issue 4, p582
Academic Journal
Abstract: Background/Objective: Secondary subaortic stenosis (SSS) can occur after surgery for various congenital heart defects with or without initial left ventricular outflow tract obstruction (LVOTO). The objective of this study was to highlight the anatomical lesions and surgical procedures associated with the development of SSS after surgery on defects without initial LVOTO. Methods: A retrospective study of 4710 patients was performed (1984–2005). The criterion for inclusion was a fixed subaortic obstruction requiring surgery, after an open- or closed-heart operation. The criterion for exclusion was an LVOTO at the time of the first operation. Results: Twenty-eight patients were studied. The mean age at initial surgery was 32 months (4 days–47 years; median: 2 months). SSS occurred after three main types of surgery: repair of coarctation of the aorta, repair of AVSD and LV–aorta rerouting for double outlet right ventricle or transposition of great arteries. The mean delay of occurrence was 4.4 years (2 months–19 years). Frequently associated initial anatomical conditions were coarctation of the aorta (40%), lesions of the mitral valve (32%), bicuspid aortic valve (21%) and left superior vena cava (LSVC) (14%). Preoperative anatomical lesions of the LVOT were present in 93% of the cases. After the initial operation, only one patient had a mean echo-Doppler pressure gradient across the LVOT>20mmHg. SSS was most frequently a subaortic membrane (n =23). The mean pressure gradient across SSS at the time of reoperation was 47±29mmHg. Five patients developed a second SSS after 7.4 years (mean). One patient developed a third SSS. No patient died. When compared with patients without SSS, significant risk factors for SSS were low age at surgery (32 vs 74.9 months, p <10−4), pre-existing coarctation of the aorta (40 vs 10%, p <10−4), bicuspid aortic valve (21 vs 6%, p =0.002) and LSVC (14 vs 4%, p =0.02). Conclusions: SSS development is multifactorial, depending on initial anatomical lesions and initial surgery. Low age at initial surgery, coarctation of the aorta, bicuspid aortic valve and LSVC significantly increase the risk of SSS. These elements warrant long-term follow-up for early detection of SSS.


Related Articles

  • Independent Risk Factors for Cardiac Operations in Adults With Congenital Heart Disease: A Retrospective Study of 543 Operations for 500 Patients. Vogt, Manfred; Hörer, Jürgen; Grünewald, Sophie; Otto, Daniela; Kaemmerer, Harald; Schreiber, Christian; Hess, John // Pediatric Cardiology;Jan2012, Vol. 33 Issue 1, p75 

    Adults with congenital heart disease (CHD) are an increasing population requiring cardiac operations. To date, the perioperative risk factors for this group have not been identified. This study aimed to identify clinical, morphologic, and hemodynamic risk factors for an adverse outcome. This...

  • Results of Fontan operation in patients with atrioventricular valve regurgitation. Podzolkov, Vladimir P.; Chiaureli, Mikhail R.; Yurlov, Ivan A.; Zelenikin, Mikhail M.; Kovalev, Dmitry V.; Dontsova, Vera I.; Astrakhantseva, Tatiana O.; Putiato, Neele A.; Zaets, Sergey B. // European Journal of Cardio-Thoracic Surgery;Aug2015, Vol. 48 Issue 2, p308 

    OBJECTIVES: The influence of concomitant atrioventricular valve regurgitation on the results of Fontan operation remains disputable. The goal of this study was to compare early and late results of Fontan operation performed in patients with mild or moderate-to-severe atrioventricular valve...

  • Ductal Stent Implantation in Tetralogy of Fallot with Aortic Arch Abnormality. Tahsin Tola, Hasan; Ergul, Yakup; Saygi, Murat; Ozyilmaz, Isa; Guzeltas, Alper; Odemis, Ender // Texas Heart Institute Journal;May2015, Vol. 42 Issue 3, p281 

    Stenting of patent ductus arteriosus is an alternative to palliative cardiac surgery in newborns with duct-dependent or decreased pulmonary circulation; however, the use of this technique in patients with an aortic arch abnormality presents a challenge. Tetralogy of Fallot is a congenital heart...

  • Risk stratification for adult congenital heart surgery van Gameren, Menno; Putman, Léon M.; Takkenberg, Johanna J.M.; Bogers, Ad J.J.C. // European Journal of Cardio-Thoracic Surgery;Apr2011, Vol. 39 Issue 4, p490 

    Abstract: Objective: At this moment, no risk stratification models are available for adult congenital cardiac surgery. This study aims to identify a suitable stratification tool for the adult congenital heart surgery population. Pediatric congenital cardiac surgery score models were therefore...

  • Unexpected deaths and unplanned re-admissions in infants discharged home after cardiac surgery: a systematic review of potential risk factors. Tregay, Jenifer; Wray, Jo; Bull, Catherine; Franklin, Rodney C.; Daubeney, Piers; Barron, David J.; Brown, Katherine; Knowles, Rachel L. // Cardiology in the Young;Jun2015, Vol. 25 Issue 5, p839 

    BackgroundBabies with CHDs are a particularly vulnerable population with significant mortality in their 1st year. Although most deaths occur in the hospital within the early postoperative period, around one-fifth of postoperative deaths in the 1st year of life may occur after hospital discharge...

  • Hybrid procedures can reduce the risk of congenital cardiovascular surgery. Schmitz, Christoph; Esmailzadeh, Bahman; Herberg, Ulrike; Lang, Nora; Sodian, Ralf; Kozlik-Feldmann, Rainer; Welz, Armin; Breuer, Johannes // European Journal of Cardio-Thoracic Surgery;Oct2008, Vol. 34 Issue 4, p718 

    Abstract: Background: Minimally invasive operations and percutaneous interventions are well-accepted options in the treatment of congenital heart defects. However, percutaneous interventions may be associated with an increased risk due to limited vascular access or a very tortuous catheter...

  • Adult congenital heart disease: experience with the surgical approach. Vasconcelos Amaral, Fernando Tadeu; Rodrigues, Alfredo José; Manso, Paulo Henrique; Schmidt, André; Kolachinski, Maria Fernanda; Carbone, Clovis; Sgarbieri, Ricardo Nilson; de Andrade Vicente, Walter Vilela // Brazilian Journal of Cardiovascular Surgery;jul-sep2013, Vol. 28 Issue 3, p371 

    Objective: To report the institution experience with the surgical treatment of adults with congenital heart disease due to the increasing number of these patients and the need for a better discussion of the subject. Methods: Retrospective analysis describing demographic data, risk factors and...

  • Extra-corporeal life support following cardiac surgery in children: analysis of risk factors and survival in a single institution Alsoufi, Bahaaldin; Al-Radi, Osman O.; Gruenwald, Colleen; Lean, Lynn; Williams, William G.; McCrindle, Brian W.; Caldarone, Christopher A.; Van Arsdell, Glen S. // European Journal of Cardio-Thoracic Surgery;Jun2009, Vol. 35 Issue 6, p1004 

    Abstract: Objective: Application of extra-corporeal life support (ECLS) following pediatric cardiac surgery varies between different institutions based on manpower availability and philosophy towards ECLS utilization. We examined a large single institution experience with postoperative ECLS in...

  • PREVALENCE AND RISK FACTORS OF MORTALITY AFTER SURGERY FOR CONGENITAL HEART DISEASE IN TABRIZ, IRAN: A five year retrospective analysis. Sohrab, Negargar; Alireza, Yagoubi; Ata, Mahmoodpoor; Mahmoud, Samadi; Bahram, Qaderi; Azad, Rahmani; Etemadi, Sahar // Pakistan Journal of Medical Sciences;Apr2010, Vol. 26 Issue 2, p267 

    Objective: The mortality rate after surgeries for congenital heart disorders is the most important factor for determination of the quality of these operations. A study that evaluate the mortality rate of these surgeries has not been done till now in Iran. Therefore, the purpose of this study was...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics