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.	张旌, 徐海涛, 陈亮, 等. 改良扩大 Morrow 手术治疗儿童肥厚型梗阻性心肌病的临床研究. 中国循环杂志, 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.	郭荣龙, 王强, 李巅远, 等. 室间隔心肌切除术对低龄儿童肥厚型梗阻性心肌病的临床疗效及早期随访结果. 中国循环杂志, 2015, 30(5): 460-464.
34.	于伟, 姜胜利, 任崇雷, 等. 主动脉瓣下狭窄的外科治疗. 中国体外循环杂志, 2015, 13(1): 37-39.
35.	李晓锋, 马维国, 朱耀斌, 等. 主动脉瓣下隔膜的外科矫治. 中国胸心血管外科临床杂志, 2014, 21(3): 307-311.
36.	乔刚, 张国报, 程兆云. 手术治疗主动脉瓣下狭窄 11 例. 新乡医学院学报, 2013, 30(12): 1003-1004.
37.	朱平, 张镜芳, 庄建, 等. 先天性主动脉瓣下狭窄 103 例的外科治疗. 岭南心血管病杂志, 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.	李晓涛, 孙国成, 雷军荣, 等. Konno 术和改良 Konno 术在治疗严重左室流出道狭窄中的应用研究. 陕西医学杂志, 2018, 47(8): 1047-1049.
40.	邹明晖, 马力, 夏园生, 等. Ross-Konno 手术治疗儿童主动脉瓣及瓣下狭窄的临床疗效. 中国胸心血管外科临床杂志, 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. 张旌, 徐海涛, 陈亮, 等. 改良扩大 Morrow 手术治疗儿童肥厚型梗阻性心肌病的临床研究. 中国循环杂志, 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. 郭荣龙, 王强, 李巅远, 等. 室间隔心肌切除术对低龄儿童肥厚型梗阻性心肌病的临床疗效及早期随访结果. 中国循环杂志, 2015, 30(5): 460-464.
34. 于伟, 姜胜利, 任崇雷, 等. 主动脉瓣下狭窄的外科治疗. 中国体外循环杂志, 2015, 13(1): 37-39.
35. 李晓锋, 马维国, 朱耀斌, 等. 主动脉瓣下隔膜的外科矫治. 中国胸心血管外科临床杂志, 2014, 21(3): 307-311.
36. 乔刚, 张国报, 程兆云. 手术治疗主动脉瓣下狭窄 11 例. 新乡医学院学报, 2013, 30(12): 1003-1004.
37. 朱平, 张镜芳, 庄建, 等. 先天性主动脉瓣下狭窄 103 例的外科治疗. 岭南心血管病杂志, 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. 李晓涛, 孙国成, 雷军荣, 等. Konno 术和改良 Konno 术在治疗严重左室流出道狭窄中的应用研究. 陕西医学杂志, 2018, 47(8): 1047-1049.
40. 邹明晖, 马力, 夏园生, 等. Ross-Konno 手术治疗儿童主动脉瓣及瓣下狭窄的临床疗效. 中国胸心血管外科临床杂志, 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