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Chapter 16 - Subvalvular Aortic Stenosis

from Section 3 - Left-Sided Obstructive Lesions

Published online by Cambridge University Press:  09 September 2021

By
Rahul G. Baijal
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

Subvalvular aortic stenosis is a progressive left-sided obstructive lesion, usually consisting of a discrete membrane, fibromuscular ridge, or tunnel. Surgical intervention is preferred over catheter intervention when the gradient across the lesion is greater than 40 mm Hg or aortic insufficiency has developed across the aortic valve. Perioperative anesthetic goals include maintaining adequate preload, afterload, and a low to normal heart rate.

Keywords

anesthesiaaortic stenosischildrenleft ventricular outflow tract obstructionnoncardiac surgerysubvalvular aortic stenosis
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 97 - 104
Publisher: Cambridge University Press
Print publication year: 2021

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References

Suggested Reading

Bengur, A. R., Snider, A. R., Serwer, G. A., et al. Usefulness of the Doppler mean gradient in evaluation of children with aortic valve stenosis and comparison to gradient at catheterization. Am J Cardiol 1989; 64: 756–61.CrossRefGoogle ScholarPubMed
Braunwald, E., Goldblatt, A., Aygen, M. M., et al. Congenital aortic stenosis. I. Clinical and hemodynamic findings in 100 patients. II Surgical treatment and the results of operation. Circulation 1963; 27: 426–62.CrossRefGoogle ScholarPubMed
Lopes, R., Lourenço, P., Gonçalves, A., et al. The natural history of congenital subaortic stenosis. Congenit Heart Di 2011; 6: 417–23.Google ScholarPubMed
Nishimura, R. A., Otto, C. M., Bobo, R. O., et al. 2014 AHA/ACC guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: e57-e185.CrossRefGoogle Scholar
Pickard, S. S., Geva, A., Gauvreau, K., et al. Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children. Heart 2015; 101: 1547–53.CrossRefGoogle ScholarPubMed
Talwar, S., Anand, A., Gupta, S. K., et al. Resection of subaortic membrane for discrete subaortic stenosis. J Card Surg 2017; 32: 430–35.Google Scholar
Uysal, F., Bostan, O. M., Signak, I. S., et al. Evaluation of subvalvular aortic stenosis in children: a 16-year single-center experience. Pediatr Cardiol 2013; 34: 1409–14.CrossRefGoogle ScholarPubMed
Vincent, W. R., Buckberg, G. D., and Hoffman, J. I. Left ventricular subendocardial ischemia in severe valvar and supravalvar aortic stenosis: a common mechanism. Circulation 1974; 49: 326–33.CrossRefGoogle ScholarPubMed
Vlahos, A. P., Marx, G. R., McElhinney, D., et al. Clinical utility of Doppler echocardiography in assessing aortic stenosis severity and predicting need for intervention in children. Pediatr Cardiol 2008; 29: 507–14.CrossRefGoogle ScholarPubMed

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