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Ann Thorac Surg 1991;52:654-661
© 1991 The Society of Thoracic Surgeons


Articles

Surgical management of diffuse subaortic stenosis: An integrated approach

Pascal R. Vouhé, MD*, Jean-Yves Neveux, MD

Service de Chirurgie Cardiovasculaire et Thoracique, Hôpital Laënnec, Paris, France

Accepted for publication May 10, 1991.

* Address reprint requests to Dr Vouhé, Service de Chirurgie Cardiaque, Hôpital Laënnec, 42, rue de Sèvres, 75340 Paris Cedex 07, France.

An integrated approach to the surgical management of diffuse subaortic stenosis has been designed to provide adequate relief of left ventricular outflow tract obstruction whatever the anatomical features encountered at operation. This approach was used in 22 patients with tunnel subaortic stenosis (19 patients) or diffuse hypertrophic obstructive cardiomyopathy (3 patients). The obstructive tissue was resected through an aortoseptal approach. In 18 patients, associated hypoplasia of the aortic orifice necessitated aortic valve replacement using the Konno procedure; in 4 patients with a normal-sized aortic orifice, the native aortic valve was preserved. There were two early deaths and one late death (all after a Konno operation). Long-term adequate relief of left ventricular outflow tract obstruction was achieved in all survivors. Operation for diffuse subaortic stenosis should be performed with two main goals: (1) to obtain complete relief of the left ventricular outflow tract obstruction by the appropriate procedure and (2) to preserve the native aortic valve whenever possible, particularly in young patients.




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