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Eur J Cardiothorac Surg 1999;14:296-303
© 1999 Elsevier Science NL

Discrete subaortic stenosis: an acquired heart disease

Division of Cardiopulmonary Surgery, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201-3098, USA

Received 29 December 1997; received in revised form 14 April 1998; accepted 21 April 1998.

Corresponding author. Tel.: 1 503 4947820; fax: +1 503 4947829/2276107.

Objective: To determine the anatomic variables in the left ventricular outflow tract in patients with subaortic stenosis. Methods: Between 1982 and 1996, 36 patients were operated on with the `discrete' form of subaortic stenosis (DSS). The mean time of follow up was 7.4 years with a range of 4 months–14 years. There were 25 male and 11 female patients. Mean age at operation was 7.1 years with a range of 9 months–47 years. Results: At the time of surgery, the mitral valve apparatus and interventricular septum were found to be rotated 60–90° in a counterclockwise fashion with anterior displacement into the left ventricular outflow tract in 30 (83%) patients. Subaortic ridge resection with a deep septal myectomy was performed in 32 patients and the remaining four patients had subaortic ridge resection alone. The reoperation free rate at 5 and 10 years were 74±9% and 60±12%, respectively. Reoperations for recurrent disease were performed in 10 (27.7%) patients. No operative or late follow up deaths were encountered. Conclusion: We conclude that DSS is an acquired disease due to a pre-existing anatomic alteration in the mitral valve apparatus and interventricular septum. In addition, recurrence rates are high and physicians should not be mislead by the benign nomenclature its name implies.

Key Words: Subaortic stenosis • Left ventricular outflow tract