A retrospective review in 50 patients with subaortic stenosis and intact ventricular septum: 5-year surgical experience.

We reviewed the surgical outcomes in adults and children with subaortic stenosis and intact ventricular septum in the current era. The case notes of 50 patients were reviewed for retrospective evaluation of preoperative, intraoperative and postoperative data. Data of primary operations during the period 2000-2005 were compared with data from patients who had re-do surgery during the same period. Thirty-five patients had primary operation and 15 patients had re-do surgery. The median age at primary operation was eight years (range 3 to 44), at second operation was 14 years (range 9 to 26) and at third operation was 15 (range 9 to 47). The entire group had been followed up postoperatively for a median of 2.5 years (range 0 to 5). Pre-operatively, aortic regurgitation was moderate in 13 and severe in three patients. Moderate to severe aortic regurgitation was present in 7 (20%) patients with primary operations and 9 (60%) patients with re-do surgery (P=0.01). Reviewing the first operations of all the re-dos (15 patients) in our series, one patient had myectomy and the rest (14 patients) had isolated resection. Aortic valve regurgitation is more prevalent in patients with recurrent subaortic stenosis. Addition of myectomy is better than shelf resection only.

Geometry of the left ventricular outflow tract in fixed subaortic stenosis and intact ventricular septum: an echocardiographic study in children and adults.

OBJECTIVE: We compared the echocardiographic geometry of the preoperative and postoperative left ventricular outflow tract in children and adults with isolated fixed subaortic stenosis with age- and weight-matched controls to elucidate whether the geometry can be modified when surgical intervention is performed at a younger age. METHODS: The mitral-aortic valve distance, aortic valve diameter, aorto-left ventricular septal angle, degree of aortic valve dextroposition, aortic valve-subaortic stenosis distance, width of left ventricular outflow tract, left ventricle wall thickness, and septal thickness were determined preoperatively and postoperatively in 21 patients and 21 controls. The measurements were indexed to body surface area. Patients were divided into 3 age groups: group 1 comprised 9 patients aged 1 to 10 years, group 2 comprised 8 patients aged 11 to 20 years, and group 3 comprised 4 patients aged 21 years or more. RESULTS: Compared with controls, patients had a significantly wider mitral-aortic separation (group 1, P = .003; group 2, P = .02), a steeper aortoseptal angle (group 1, P = .02; group 3, P = .03), a smaller left ventricular outflow tract width (group 1, P = .003; group 2, P = .01), a marked aortic valve dextroposition (groups 1 and 3), an increased left ventricle wall thickness (group 1, P = .03), and an increased septal thickness (group 1, P = .01). There was a significant difference between preoperative and postoperative values in aortoseptal angle and left ventricular outflow tract width in patients up to 10 years of age (P = .02 and P = .01, respectively). CONCLUSIONS: Hearts with isolated subaortic stenosis have abnormal left ventricular outflow tract geometry that postoperatively showed changes in left ventricular outflow tract width and aortoseptal angle. Compared with controls, the aortoseptal angle does not "normalize" when surgery is performed in older patients, suggesting that left ventricular outflow tract geometry may be remodeled in younger patients.

Transoesophageal echocardiogram identifying the source of endoleak after combined open/endovascular repair of a type 3 thoracoabdominal aortic aneurysm.

Open repair of thoracic aortic aneurysms is associated with significant morbidity and mortality. The introduction of endovascular repair has reduced both the morbidity and mortality. However, endovascular stent repair can be complicated by endoleaks. We report here the successful treatment of a type 2 endoleak following endovascular repair of a thoracoabdominal aortic aneurysm, using transesophageal echocardiography to assist in the localization of the thoracic endoleak.