Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-26T20:04:44.173Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-term follow-up of subvalvular aortic stenosis in children: a single-centre experience

Part of: Echocardiography

Published online by Cambridge University Press:  29 November 2021

Mehmet G. Ramoğlu Open the ORCID record for Mehmet G. Ramoğlu [Opens in a new window] ,
Selen Karagözlü Open the ORCID record for Selen Karagözlü [Opens in a new window] ,
Tayfun Uçar Open the ORCID record for Tayfun Uçar [Opens in a new window] ,
Zeynep Eyileten Open the ORCID record for Zeynep Eyileten [Opens in a new window] ,
Adnan Uysalel Open the ORCID record for Adnan Uysalel [Opens in a new window] ,
Semra Atalay Open the ORCID record for Semra Atalay [Opens in a new window]  and
Ercan Tutar Open the ORCID record for Ercan Tutar [Opens in a new window]
Mehmet G. Ramoğlu
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
Selen Karagözlü
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
Tayfun Uçar
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
Zeynep Eyileten
Affiliation:
Department of Pediatric Cardiovascular Surgery, School of Medicine, Ankara University, Ankara, Turkey
Adnan Uysalel
Affiliation:
Department of Pediatric Cardiovascular Surgery, School of Medicine, Ankara University, Ankara, Turkey
Semra Atalay
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
Ercan Tutar*
Affiliation:
Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
*
Author for correspondence: Prof. Dr E. Tutar, Ankara Üniversitesi Tıp Fakültesi Hastanesi, Tıp Fakültesi Caddesi, Cebeci, Çankaya, Ankara06590, Turkey. Tel: +905323451201; Fax: +903123106371. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The aim of this study is to evaluate clinical and surgical outcomes of children with subaortic stenosis, to determine the risk factors for surgery and reoperation and to compare isolated subaortic stenosis and those concomitant with CHDs.

Methods:

The study involved 80 children with subaortic stenosis. The patients were first classified as isolated and CHD group, and the isolated group was further classified as membranous/fibromuscular group. The initial, pre-operative, post-operative and the most recent echocardiographic data, demographic properties and follow-up results of the groups were analysed and compared. The correlation of echocardiographic parameters with surgery and reoperation was evaluated.

Results:

There was a significant male predominance in all groups. The frequency of the membranous type was higher than the fibromuscular type in the whole and the CHD group. The median time to the first operation was 4.6 years. Thirty-five (43.7%) patients underwent surgery, 5 of 35 (14%) patients required reoperation. The rate of surgery was similar between groups, but reoperation was significantly higher in the isolated group. The gradient was the most important factor for surgery and reoperation in both groups. In the isolated group besides gradient, mitral-aortic separation was the only echocardiographic parameter correlated with surgery and reoperation.

Conclusion:

Reoperation is higher in isolated subaortic stenosis but similar in membranous and fibromuscular types. Early surgery may be beneficial in preventing aortic insufficiency but does not affect the rate of reoperation. Higher initial gradients are associated with adverse outcomes, recurrence and reoperation.

Keywords

Subvalvular aortic stenosissurgeryreoperationmitral-aortic separationaortoseptal angle
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 6 , June 2022 , pp. 980 - 987
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Friedland-Little, J, Zampi, J, Gajarski, R. Aortic stenosis. In: Allen, HD, Shaddy, RE, Penny, DJ, Cetta, F, Feltes, TF (eds). Moss and Adams' heart disease in infants, children, and adolescents including the fetus and young adult. Wolters Kluwer, Philadelphia, 2016: 1989–2036.Google Scholar
Uysal, F, Bostan, OM, Signak, IS, Semizel, E, Cil, E. Evaluation of subvalvular aortic stenosis in children: a 16-year single-center experience. Pediatr Cardiol 2013; 34: 1409–1414.10.1007/s00246-013-0664-xCrossRefGoogle ScholarPubMed
Tal, N, Golender, J, Rechtman, Y, Tidhar, D, Erez, E. Long-term aortic valve function in patients with or without surgical treatment for discrete subaortic stenosis. Pediatr Cardiol 2021; 42: 324–330.10.1007/s00246-020-02486-wCrossRefGoogle ScholarPubMed
Tutar, HE, Atalay, S, Turkay, S, Gumus, H, Imamoglu, A. Echocardiographic, morphologic, and geometric variations of the left ventricular outflow tract: possible role in the pathogenesis of discrete subaortic stenosis. Angiology 2000; 51: 213–221.Google ScholarPubMed
Shar, JA, Keswani, SG, Grande-Allen, KJ, Sucosky, P. Computational assessment of valvular dysfunction in discrete subaortic stenosis: a parametric study. Cardiovasc Eng Technol 2021. Online ahead of print. Doi: 10.1007/s13239-020-00513-8.10.1007/s13239-020-00513-8CrossRefGoogle ScholarPubMed
Barkhordarian, R, Wen-Hong, D, Li, W, Josen, M, Henein, M, Ho, SY. Geometry of the left ventricular outflow tract in fixed subaortic stenosis and intact ventricular septum: an echocardiographic study in children and adults. J Thorac Cardiovasc Surg 2007; 133: 196–203.10.1016/j.jtcvs.2006.09.010CrossRefGoogle ScholarPubMed
Mulla, S, Siddiqui, WJ. Subaortic stenosis. StatPearls, Treasure Island, FL, 2021.Google Scholar
Vogt, J, Dische, R, Rupprath, G, de Vivie, ER, Kotthoff, S, Kececioglu, D. Fixed subaortic stenosis: an acquired secondary obstruction? A twenty-seven year experience with 168 patients. Thorac Cardiovasc Surg 1989; 37: 199–206.CrossRefGoogle ScholarPubMed
Geva, A, McMahon, CJ, Gauvreau, K, Mohammed, L, del Nido, PJ, Geva, T. Risk factors for reoperation after repair of discrete subaortic stenosis in children. J Am Coll Cardiol 2007; 50: 1498–1504.10.1016/j.jacc.2007.07.013CrossRefGoogle ScholarPubMed
Pickard, SS, Geva, A, Gauvreau, K, del Nido, PJ, Geva, T. Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children. Heart 2015; 101: 1547–1553.10.1136/heartjnl-2015-307460CrossRefGoogle ScholarPubMed
Lopez, L, Colan, SD, Frommelt, PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010; 23: 465–495, quiz 576-467.10.1016/j.echo.2010.03.019CrossRefGoogle ScholarPubMed
Baumgartner, HC, Hung, JC-C, Bermejo, J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2017; 18: 254–275.10.1093/ehjci/jew335CrossRefGoogle Scholar
Lancellotti, P, Tribouilloy, C, Hagendorff, A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013; 14: 611–644.10.1093/ehjci/jet105CrossRefGoogle ScholarPubMed
Masse, DD, Shar, JA, Brown, KN, Keswani, SG, Grande-Allen, KJ, Sucosky, P. Discrete subaortic stenosis: perspective roadmap to a complex disease. Front Cardiovasc Med 2018; 5: 122.10.3389/fcvm.2018.00122CrossRefGoogle ScholarPubMed
Newfeld, EA, Muster, AJ, Paul, MH, Idriss, FS, Riker, WL. Discrete subvalvular aortic stenosis in childhood. Study of 51 patients. Am J Cardiol 1976; 38: 53–61.10.1016/0002-9149(76)90062-XCrossRefGoogle ScholarPubMed
Choi, JY, Sullivan, ID. Fixed subaortic stenosis: anatomical spectrum and nature of progression. Br Heart J 1991; 65: 280–286.CrossRefGoogle ScholarPubMed
Devabhaktuni, SR, Chakfeh, E, Malik, AO, Pengson, JA, Rana, J, Ahsan, CH. Subvalvular aortic stenosis: a review of current literature. Clin Cardiol 2018; 41: 131–136.10.1002/clc.22775CrossRefGoogle ScholarPubMed
Abushaban, L, Uthaman, B, Selvan, JP, Al Qbandi, M, Sharma, PN, Mariappa, TV. Long-term follow-up and outcomes of discrete subaortic stenosis resection in children. Ann Pediatr Cardiol 2019; 12: 212–219.10.4103/apc.APC_120_18CrossRefGoogle ScholarPubMed
McMahon, CJ, Gauvreau, K, Edwards, JC, Geva, T. Risk factors for aortic valve dysfunction in children with discrete subvalvar aortic stenosis. Am J Cardiol 2004; 94: 459–464.10.1016/j.amjcard.2004.05.005CrossRefGoogle ScholarPubMed
Karamlou, T, Gurofsky, R, Bojcevski, A, et al. Prevalence and associated risk factors for intervention in 313 children with subaortic stenosis. Ann Thorac Surg 2007; 84: 900–906, discussion 906.CrossRefGoogle ScholarPubMed
Brauner, R, Laks, H, Drinkwater, DC Jr., Shvarts, O, Eghbali, K, Galindo, A. Benefits of early surgical repair in fixed subaortic stenosis. J Am Coll Cardiol 1997; 30: 1835–1842.CrossRefGoogle ScholarPubMed
Somerville, J, Stone, S, Ross, D. Fate of patients with fixed subaortic stenosis after surgical removal. Br Heart J 1980; 43: 629–647.10.1136/hrt.43.6.629CrossRefGoogle ScholarPubMed
Binsalamah, ZM, Spigel, ZA, Zhu, H, et al. Reoperation after isolated subaortic membrane resection. Cardiol Young 2019; 29: 1391–1396.10.1017/S1047951119002336CrossRefGoogle ScholarPubMed
Carlson, L, Pickard, S, Gauvreau, K, et al. Preoperative factors that predict recurrence after repair of discrete subaortic stenosis. Ann Thorac Surg 2021; 111: 1613–1619.CrossRefGoogle ScholarPubMed
Kalfa, D, Ghez, O, Kreitmann, B, Metras, D. Secondary subaortic stenosis in heart defects without any initial subaortic obstruction: a multifactorial postoperative event. Eur J Cardiothorac Surg 2007; 32: 582–587.CrossRefGoogle ScholarPubMed