Long-Term Functional Results of Patients Operated for Isolated Discrete Subaortic Stenosis
DOI:
https://doi.org/10.1532/hsf.3821Keywords:
discrete subaortic stenosis, subaortic membrane resection, myectomy, long-term results, 2D speckle-tracking echocardiographyAbstract
Background: This study aimed to examine the long-term functional results of patients with isolated discrete subaortic stenosis who underwent subaortic membrane resection and myectomy, using transthoracic M-mode echocardiography and 2D speckle-tracking echocardiography.
Methods: Twenty patients operated for isolated discrete subaortic stenosis and 31 controls were included in the study. Patients underwent subaortic membrane resection and myectomy. During the long-term follow up, patients were evaluated with transthoracic M-mode echocardiography and 2D speckle-tracking echocardiography for functional assessment.
Results: The mean age at operation and mean duration of follow up was 8.1±5.6 years and 7.2±3.3 years, respectively. Interventricular septal thickness at diastole (0.9±0.1 vs. 0.8±0.1 cm, P = 0.001), ejection time (285.7±26.2 vs. 261.2±24.3 msec, P = 0.001), and aortic strain (15.6±3.7 vs. 10.5±4.0, P < 0.001) were significantly higher in patients. On the other hand, ejection fraction (64.9±6.1 vs. 75.1±5.4 %, P < 0.001), fractional shortening (35.0±5.1 vs. 43.7±5.1, P < 0.001), and corrected velocity circumferential fiber shortening (0.12±0.02 vs. 0.17±0.03, P < 0.001) were significantly lower, when compared with the controls. Longitudinal strain value significantly differed among the groups, with patients having significantly lower strain (18.8±1.8 vs. 20.1±2.1, P = 0.021).
Conclusion: In patients operated for isolated discrete subaortic stenosis, aortic gradient seems to continue in the long-term, with the persistence of low longitudinal strain.
References
Aboulhosn J, Child JS. 2006. Left ventricular outflow obstruction: subaortic stenosis, bicuspid aortic valve, supravalvar aortic stenosis, and coarctation of the aorta. Circulation 114:2412-22.
Abushaban L, Uthaman B, Selvan JP, Al Qbandi M, Sharma PN, Vel Mariappa T. 2019. Long term follow up and outcomes of discrete subaortic stenosis resection in children. Ann Pediatr Cardiol. 12(3):212-219.
Brauner R, Laks H, Drinkwater DC, Jr., Shvarts O, Eghbali K, Galindo A. 1997. Benefits of early surgical repair in fixed subaortic stenosis. J Am Coll Cardiol 30:1835-42.
Caivano D, Rishniw M, Baiona L, Birettoni F, Nisini N, and Porciello F. 2020. Assessment of Longitudinal Left Ventricle Deformation by 2-Dimensional Speckle Tracking Echocardiography Obtained from Different Views in Cats. Vet Sci. 6;7(3):104.
Darcin OT, Yagdi T, Atay Y, Engin C, Levent E, Buket S, et al. 2003. Discrete subaortic stenosis: surgical outcomes and follow-up results. Tex Heart Inst J 30:286-92.
Devereux RB, Reichek N. 1977. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55:613-8.
Dorobantu DM, Sharabiani MT, Martin RP, Angelini GD, Parry AJ, Caputo M, et al. 2014. Surgery for simple and complex subaortic stenosis in children and young adults: results from a prospective, procedure-based national database. J Thorac Cardiovasc Surg 148:2618-26.
Foker JE. 2013. Outcomes and questions about discrete subaortic stenosis. Circulation 127:1447-50.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. 2005. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440-63.
Leitman M, Lysyansky P, Sidenko S, Shir V, Peleg E, Binenbaum M, et al. 2004. Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function. J Am Soc Echocardiogr 17:1021-9.
Oliver JM, Gonzalez A, Gallego P, Sanchez-Recalde A, Benito F, Mesa JM. 2001. Discrete subaortic stenosis in adults: increased prevalence and slow rate of progression of the obstruction and aortic regurgitation. J Am Coll Cardiol 38:835-42.
Opotowsky AR, Pickard SS, Geva T. 2017. Imaging adult patients with discrete subvalvar aortic stenosis. Curr Opin Cardiol. 32(5):513-520.
Oxborough D, Batterham AM, Shave R, Artis N, Birch KM, Whyte G, et al. 2009. Interpretation of two-dimensional and tissue Doppler-derived strain (epsilon) and strain rate data: is there a need to normalize for individual variability in left ventricular morphology? Eur J Echocardiogr 10:677-82.
Qureshi A, Awuor S, Martinez M. 2015. Adult presentation of subaortic stenosis: another great hypertrophic cardiomyopathy mimic. Heart Lung Circ 24:e7-e10.
Rayburn ST, Netherland DE, Heath BJ. 1997. Discrete membranous subaortic stenosis: improved results after resection and myectomy. Ann Thorac Surg 64:105-9.
Rohlicek CV, del Pino SF, Hosking M, Miro J, Côté JM, Finley J, et al. 1999. Natural history and surgical outcomes for isolated discrete subaortic stenosis in children. Heart 82:708-13.
Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW, Brown JW. 2006. Long-term results of surgical repair in patients with congenital subaortic stenosis. Interact Cardiovasc Thorac Surg 5:227-33.
Tal N, Golender J, Rechtman Y, Tidhar D, Erez E. 2021. Long-Term Aortic Valve Function in Patients With or Without Surgical Treatment for Discrete Subaortic Stenosis. Pediatr Cardiol. 42(2):324-330.
Van der Linde D, Roos-Hesselink JW, Rizopoulos D, Heuvelman HJ, Budts W, van Dijk AP, et al. 2013. Surgical outcome of discrete subaortic stenosis in adults: a multicenter study. Circulation 127:1184-91, e1-4.
Van der Linde D, Takkenberg JJ, Rizopoulos D, Heuvelman HJ, Budts W, van Dijk AP, et al. 2013. Natural history of discrete subaortic stenosisin adults: a multicentre study. Eur Heart J 34:1548-56.
