Chinese expert consensus on the surgical treatment of congenital heart diseases (9): Subvalvar aortic stenosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 DONG Shuo ,  YAN Jun ,  LI Shoujun

Department of Pediatric Cardiac Surgery, Fuwai Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, 100037, Beijing, P.R.China;

Corresponding?author：

YAN Jun, Email: yanjun.1112@aliyun.com

Keywords：

Congenital heart disease; subvalvar aortic stenosis; surgery; treatment; expert consensus

DOI：

10.7507/1007-4848.202005082

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Subvalvar aortic stenosis (SAS) refers to a type of disease in which the stenosis of the left ventricular outflow tract is below the aortic valve. It is a disease spectrum that includes multiple diseases ranging from the simple to the complex. This disease has its own characteristics according to different types. The diagnostic criteria and treatment strategies are basically unified, but there are still some disputes about the surgical treatment. Based on the evidence-based data and expert consensus, this paper makes a comprehensive summary and recommendations on the clinical classification, diagnostic criteria and surgical treatment strategies of SAS, which is more suitable for the clinical characteristics of SAS patients in China and more clinically operable.

Citation： DONG Shuo, YAN Jun, LI Shoujun. Chinese expert consensus on the surgical treatment of congenital heart diseases (9): Subvalvar aortic stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(10): 1113-1118. doi: 10.7507/1007-4848.202005082 Copy

1.	Barkhordarian R, Wen-Hong D, Li W, et al. 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(1): 196-203.
2.	Maron BJ, Redwood DR, Roberts WC, et al. Tunnel subaortic stenosis: left ventricular outflow tract obstruction produced by fibromuscular tubular narrowing. Circulation, 1976, 54(3): 404-416.
3.	Choi JY, Sullivan ID. Fixed subaortic stenosis: anatomical spectrum and nature of progression. Br Heart J, 1991, 65(5): 280-286.
4.	Patanè S, Patanè F, Marte F, et al. Subvalvular aortic stenosis associated with valvular aortic regurgitation in young child. Int J Cardiol, 2009, 133(2): e81-e83.
5.	de Vries AG, Hess J, Witsenburg M, et al. Management of fixed subaortic stenosis: a retrospective study of 57 cases. J Am Coll Cardiol, 1992, 19(5): 1013-1017.
6.	Serraf A, Zoghby J, Lacour-Gayet F, et al. Surgical treatment of subaortic stenosis: a seventeen-year experience. J Thorac Cardiovasc Surg, 1999, 117(4): 669-678.
7.	Reis RL, Peterson LM, Mason DT, et al. Congenital fixed subvalvular aortic stenosis. An anatomical classification and correlations with operative results. Circulation, 1971, 43(5 Suppl): Ⅰ11-Ⅰ18.
8.	Rhodes LA, Colan SD, Perry SB, et al. Predictors of survival in neonates with critical aortic stenosis. Circulation, 1991, 84(6): 2325-2335.
9.	Hartyánszky IL, Kádár K, Bojeldein S, et al. Mitral valve anomalies obstructing left ventricular outflow. Eur J Cardiothorac Surg, 1997, 12(3): 504-506.
10.	Kalfa D, Ghez O, Kreitmann B, et al. Secondary subaortic stenosis in heart defects without any initial subaortic obstruction: A multifactorial postoperative event. Eur J Cardiothorac Surg, 2007, 32(4): 582-587.
11.	Tchervenkov CI, Jacobs JP, Weinberg PM, et al. The nomenclature, definition and classification of hypoplastic left heart syndrome. Cardiol Young, 2006, 16(4): 339-368.
12.	Shem-Tov A, Schneeweiss A, Motro M, et al. Clinical presentation and natural history of mild discrete subaortic stenosis. Follow-up of 1-17 years. Circulation, 1982, 66(3): 509-512.
13.	Katz NM, Buckley MJ, Liberthson RR. Discrete membranous subaortic stenosis. Report of 31 patients, review of the literature, and delineation of management. Circulation, 1977, 56(6): 1034-1038.
14.	Morrow AG, Fort L, Roberts WC, et al. Discrete subaortic stenosis complicated by aortic valvular regurgitation. Clinical, hemodynamic, and pathologic studies and the results of operative treatment. Circulation, 1965, 31: 163-171.
15.	Yacoub M, Onuzo O, Riedel B, et al. Mobilization of the left and right fibrous trigones for relief of severe left ventricular outflow obstruction. J Thorac Cardiovasc Surg, 1999, 117(1): 126-132.
16.	Cooley DA, Garrett JR. Septoplasty for left ventricular outflow obstruction without aortic valve replacement: a new technique. Ann Thorac Surg, 1986, 42(4): 445-448.
17.	van Son JA, Falk V, Mohr FW. Ross-Konno operation with resection of endocardial fibroelastosis for critical aortic stenosis with borderline-sized left ventricle in neonates. Ann Thorac Surg, 1997, 63(1): 112-116.
18.	Ross D. Application of homografts in clinical surgery. J Card Surg, 1987, 2(1 Suppl): 175-183.
19.	Misbach GA, Turley K, Ullyot DJ, et al. Left ventricular outflow enlargement by the Konno procedure. J Thorac Cardiovasc Surg, 1982, 84(5): 696-703.
20.	Laredo M, Khraiche D, Raisky O, et al. Long-term results of the modified konno procedure in high-risk children with obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg, 2018, 156(6): 2285-2294.
21.	Milsom FP, Doty DB. Aortic valve replacement and mitral valve repair with allograft. J Card Surg, 1993, 8(3): 350-357.
22.	張旌, 徐海濤, 陳亮, 等. 改良擴大 Morrow 手術治療兒童肥厚型梗阻性心肌病的臨床研究. 中國循環雜志, 2018, 33(10): 1011-1015.
23.	Xu H, Yan J, Wang Q, et al. Extended septal myectomy for hypertrophic obstructive cardiomyopathy in children and adolescents. Pediatr Cardiol, 2016, 37(6): 1091-1097.
24.	Kotkar KD, Said SM, Dearani JA, et al. Hypertrophic obstructive cardiomyopathy: The Mayo clinic experience. Ann Cardiothorac Surg, 2017, 6(4): 329-336.
25.	Schleihauf J, Cleuziou J, Pabst von Ohain J, et al. Clinical long-term outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in infants. Eur J Cardiothorac Surg, 2018, 53(3): 538-544.
26.	Jonas RA, Keane JF, Lock JE. Aortic valve-preserving procedure for enlargement of the left ventricular outflow tract and mitral anulus. J Thorac Cardiovasc Surg, 1998, 115(5): 1219-1222.
27.	Boucek MM, Mashburn C, Dunn SM, et al. Pediatric heart transplantation after declaration of cardiocirculatory death. N Engl J Med, 2008, 359(7): 709-714.
28.	Elliott PM, Anastasakis A, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(39): 2733-2779.
29.	Tabatabaie MB, Ghavidel AA, Yousefnia MA, et al. Classic Konno-Rastan procedure: indications and results in the current era. Asian Cardiovasc Thorac Ann, 2006, 14(5): 377-381.
30.	Daenen WJ. Repair of complex left ventricular outflow tract obstruction with a pulmonary autograft. J Heart Valve Dis, 1995, 4(4): 364-367.
31.	Reddy VM, Rajasinghe HA, Teitel DF, et al. Aortoventriculoplasty with the pulmonary autograft: The "Ross-Konno" procedure. J Thorac Cardiovasc Surg, 1996, 111(1): 158-165.
32.	Alexander PMA, Nugent AW, Daubeney PEF, et al. Long-term outcomes of hypertrophic cardiomyopathy diagnosed during childhood: results from a national population-based study. Circulation, 2018, 138(1): 29-36.
33.	郭榮龍, 王強, 李巔遠, 等. 室間隔心肌切除術對低齡兒童肥厚型梗阻性心肌病的臨床療效及早期隨訪結果. 中國循環雜志, 2015, 30(5): 460-464.
34.	于偉, 姜勝利, 任崇雷, 等. 主動脈瓣下狹窄的外科治療. 中國體外循環雜志, 2015, 13(1): 37-39.
35.	李曉鋒, 馬維國, 朱耀斌, 等. 主動脈瓣下隔膜的外科矯治. 中國胸心血管外科臨床雜志, 2014, 21(3): 307-311.
36.	喬剛, 張國報, 程兆云. 手術治療主動脈瓣下狹窄 11 例. 新鄉醫學院學報, 2013, 30(12): 1003-1004.
37.	朱平, 張鏡芳, 莊建, 等. 先天性主動脈瓣下狹窄 103 例的外科治療. 嶺南心血管病雜志, 2007, 13(3): 203-205.
38.	Zhang X, Wang W, Yan J, et al. Surgical treatment results of secondary tunnel-like subaortic stenosis after congenital heart disease operations: a 7-year, single-center experience in 25 patients. J Card Surg, 2020, 35(2): 335-340.
39.	李曉濤, 孫國成, 雷軍榮, 等. Konno 術和改良 Konno 術在治療嚴重左室流出道狹窄中的應用研究. 陜西醫學雜志, 2018, 47(8): 1047-1049.
40.	鄒明暉, 馬力, 夏園生, 等. Ross-Konno 手術治療兒童主動脈瓣及瓣下狹窄的臨床療效. 中國胸心血管外科臨床雜志, 2020, 27(4): 476-478.

1. Barkhordarian R, Wen-Hong D, Li W, et al. 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(1): 196-203.
2. Maron BJ, Redwood DR, Roberts WC, et al. Tunnel subaortic stenosis: left ventricular outflow tract obstruction produced by fibromuscular tubular narrowing. Circulation, 1976, 54(3): 404-416.
3. Choi JY, Sullivan ID. Fixed subaortic stenosis: anatomical spectrum and nature of progression. Br Heart J, 1991, 65(5): 280-286.
4. Patanè S, Patanè F, Marte F, et al. Subvalvular aortic stenosis associated with valvular aortic regurgitation in young child. Int J Cardiol, 2009, 133(2): e81-e83.
5. de Vries AG, Hess J, Witsenburg M, et al. Management of fixed subaortic stenosis: a retrospective study of 57 cases. J Am Coll Cardiol, 1992, 19(5): 1013-1017.
6. Serraf A, Zoghby J, Lacour-Gayet F, et al. Surgical treatment of subaortic stenosis: a seventeen-year experience. J Thorac Cardiovasc Surg, 1999, 117(4): 669-678.
7. Reis RL, Peterson LM, Mason DT, et al. Congenital fixed subvalvular aortic stenosis. An anatomical classification and correlations with operative results. Circulation, 1971, 43(5 Suppl): Ⅰ11-Ⅰ18.
8. Rhodes LA, Colan SD, Perry SB, et al. Predictors of survival in neonates with critical aortic stenosis. Circulation, 1991, 84(6): 2325-2335.
9. Hartyánszky IL, Kádár K, Bojeldein S, et al. Mitral valve anomalies obstructing left ventricular outflow. Eur J Cardiothorac Surg, 1997, 12(3): 504-506.
10. Kalfa D, Ghez O, Kreitmann B, et al. Secondary subaortic stenosis in heart defects without any initial subaortic obstruction: A multifactorial postoperative event. Eur J Cardiothorac Surg, 2007, 32(4): 582-587.
11. Tchervenkov CI, Jacobs JP, Weinberg PM, et al. The nomenclature, definition and classification of hypoplastic left heart syndrome. Cardiol Young, 2006, 16(4): 339-368.
12. Shem-Tov A, Schneeweiss A, Motro M, et al. Clinical presentation and natural history of mild discrete subaortic stenosis. Follow-up of 1-17 years. Circulation, 1982, 66(3): 509-512.
13. Katz NM, Buckley MJ, Liberthson RR. Discrete membranous subaortic stenosis. Report of 31 patients, review of the literature, and delineation of management. Circulation, 1977, 56(6): 1034-1038.
14. Morrow AG, Fort L, Roberts WC, et al. Discrete subaortic stenosis complicated by aortic valvular regurgitation. Clinical, hemodynamic, and pathologic studies and the results of operative treatment. Circulation, 1965, 31: 163-171.
15. Yacoub M, Onuzo O, Riedel B, et al. Mobilization of the left and right fibrous trigones for relief of severe left ventricular outflow obstruction. J Thorac Cardiovasc Surg, 1999, 117(1): 126-132.
16. Cooley DA, Garrett JR. Septoplasty for left ventricular outflow obstruction without aortic valve replacement: a new technique. Ann Thorac Surg, 1986, 42(4): 445-448.
17. van Son JA, Falk V, Mohr FW. Ross-Konno operation with resection of endocardial fibroelastosis for critical aortic stenosis with borderline-sized left ventricle in neonates. Ann Thorac Surg, 1997, 63(1): 112-116.
18. Ross D. Application of homografts in clinical surgery. J Card Surg, 1987, 2(1 Suppl): 175-183.
19. Misbach GA, Turley K, Ullyot DJ, et al. Left ventricular outflow enlargement by the Konno procedure. J Thorac Cardiovasc Surg, 1982, 84(5): 696-703.
20. Laredo M, Khraiche D, Raisky O, et al. Long-term results of the modified konno procedure in high-risk children with obstructive hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg, 2018, 156(6): 2285-2294.
21. Milsom FP, Doty DB. Aortic valve replacement and mitral valve repair with allograft. J Card Surg, 1993, 8(3): 350-357.
22. 張旌, 徐海濤, 陳亮, 等. 改良擴大 Morrow 手術治療兒童肥厚型梗阻性心肌病的臨床研究. 中國循環雜志, 2018, 33(10): 1011-1015.
23. Xu H, Yan J, Wang Q, et al. Extended septal myectomy for hypertrophic obstructive cardiomyopathy in children and adolescents. Pediatr Cardiol, 2016, 37(6): 1091-1097.
24. Kotkar KD, Said SM, Dearani JA, et al. Hypertrophic obstructive cardiomyopathy: The Mayo clinic experience. Ann Cardiothorac Surg, 2017, 6(4): 329-336.
25. Schleihauf J, Cleuziou J, Pabst von Ohain J, et al. Clinical long-term outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in infants. Eur J Cardiothorac Surg, 2018, 53(3): 538-544.
26. Jonas RA, Keane JF, Lock JE. Aortic valve-preserving procedure for enlargement of the left ventricular outflow tract and mitral anulus. J Thorac Cardiovasc Surg, 1998, 115(5): 1219-1222.
27. Boucek MM, Mashburn C, Dunn SM, et al. Pediatric heart transplantation after declaration of cardiocirculatory death. N Engl J Med, 2008, 359(7): 709-714.
28. Elliott PM, Anastasakis A, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(39): 2733-2779.
29. Tabatabaie MB, Ghavidel AA, Yousefnia MA, et al. Classic Konno-Rastan procedure: indications and results in the current era. Asian Cardiovasc Thorac Ann, 2006, 14(5): 377-381.
30. Daenen WJ. Repair of complex left ventricular outflow tract obstruction with a pulmonary autograft. J Heart Valve Dis, 1995, 4(4): 364-367.
31. Reddy VM, Rajasinghe HA, Teitel DF, et al. Aortoventriculoplasty with the pulmonary autograft: The "Ross-Konno" procedure. J Thorac Cardiovasc Surg, 1996, 111(1): 158-165.
32. Alexander PMA, Nugent AW, Daubeney PEF, et al. Long-term outcomes of hypertrophic cardiomyopathy diagnosed during childhood: results from a national population-based study. Circulation, 2018, 138(1): 29-36.
33. 郭榮龍, 王強, 李巔遠, 等. 室間隔心肌切除術對低齡兒童肥厚型梗阻性心肌病的臨床療效及早期隨訪結果. 中國循環雜志, 2015, 30(5): 460-464.
34. 于偉, 姜勝利, 任崇雷, 等. 主動脈瓣下狹窄的外科治療. 中國體外循環雜志, 2015, 13(1): 37-39.
35. 李曉鋒, 馬維國, 朱耀斌, 等. 主動脈瓣下隔膜的外科矯治. 中國胸心血管外科臨床雜志, 2014, 21(3): 307-311.
36. 喬剛, 張國報, 程兆云. 手術治療主動脈瓣下狹窄 11 例. 新鄉醫學院學報, 2013, 30(12): 1003-1004.
37. 朱平, 張鏡芳, 莊建, 等. 先天性主動脈瓣下狹窄 103 例的外科治療. 嶺南心血管病雜志, 2007, 13(3): 203-205.
38. Zhang X, Wang W, Yan J, et al. Surgical treatment results of secondary tunnel-like subaortic stenosis after congenital heart disease operations: a 7-year, single-center experience in 25 patients. J Card Surg, 2020, 35(2): 335-340.
39. 李曉濤, 孫國成, 雷軍榮, 等. Konno 術和改良 Konno 術在治療嚴重左室流出道狹窄中的應用研究. 陜西醫學雜志, 2018, 47(8): 1047-1049.
40. 鄒明暉, 馬力, 夏園生, 等. Ross-Konno 手術治療兒童主動脈瓣及瓣下狹窄的臨床療效. 中國胸心血管外科臨床雜志, 2020, 27(4): 476-478.

Next Article
Chinese expert consensus on robot-assisted pulmonary resections

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Chinese expert consensus on the surgical treatment of congenital heart diseases (9): Subvalvar aortic stenosis

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content