0074

SUBAORTIC STENOSIS WITH VENTRICULAR SEPTUM DEFECT

Li JH, Zhang ZW, Zhu XK, Hu J

Children's Hospital Affiliated Medical College of Zhejiang University, Hangzhou, China

Objective: To review the experiences in classification and surgical treatment of subaortic stenosis (SAS) with ventricular septal defect (VSD).

Method: 16 patients of SAS with VSD were treated in our hospital from Jan.1990 to Aug. 2000. There were 10 males and 6 females with a mean age of 4.8years(range from 14 month to 10 years) and a mean body weight 15.4Kg(range from 6 to 28 Kg). The associated cardiac anomalies included patent ductus arteriosus (PDA) in 2, persistent left super venacava in 2 and single coronary arterial in 1. There were 8 cases of moderate aortic valve regurgitation, which caused by the jet flow of SAS and VSD. EKG showed single left ventricular hypertrophy in 4, both left and right ventricular hypertrophy in 12, among them there were T wave abnormal change in 4. Echocardiography revealed all patients with short segmental SAS with VSD. The operation was carried out under cardiopulmonary bypass. All patients were resected SAS though VSD and patched VSD with fresh autologous pericardium patch at same time except one, whose SAS was half membrane at up ridge of VSD and very close to aortic valve was not found in the operation and closed VSD only. PDA were ligated just after CPB begin.

Result: There were no surgical deaths and postoperative complications. All patients recover smoothly with normal development. There was only 1 mild aortic valve regurgitation on echo 1 to 2 weeks postoperatively. The one with SAS unresected was followed up over 3 years without any evidence of left ventricular hypertrophy and symptom.

Conclusion: Echocardiography is not only the powerful tool for diagnosis of SAS with VSD but also play an important rule in classification. Resecting the SAS through VSD is reasonable and feasible without technique difficulty. SAS with VSD should be operated as early as possible to prevent development of aortic valve regurgitation.