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Sub-aortic Stenosis

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Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care

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Abstract

The left ventricular outflow tract is a complex of integrated anatomical structures that constitute subvalvar, valvar, and supravalvar components. Congenital left ventricular outflow tract obstruction can occur at a single level in isolation or at multiple levels. This condition affects 3–10 % of individuals with congenital heart disease and accounts for 0.25 for every 100 live births. Congenital subaortic stenosis represents a heterogeneous spectrum of lesions that cause obstruction in the left ventricular outflow tract beneath the aortic valve and is present in 8–30 % of patients with left ventricular outflow tract obstruction. The spectrum of obstruction ranges from a discrete localized fibrous or fibromuscular subaortic membrane with varying degrees of extension to a complete long diffuse fibrous tunnel subaortic stenosis. Another form of left ventricular outflow tract obstruction is a pure muscular form of hypertrophic obstructive cardiomyopathy. Infrequently, subaortic stenosis may also be the consequence of anomalous septal insertion of the mitral valve, accessory mitral valve tissue, abnormal papillary muscle insertion or muscle bands, and posterior displacement of the infundibular septum in the absence of a ventricular septal defect (with or without a subaortic membrane). Albeit the necessity for surgical intervention is well delineated, surgical timing and technique remain controversial. This chapter will focus on the three forms of subaortic stenosis (discrete form, the subaortic tunnel, and the hypertrophic obstructive cardiomyopathy) with an emphasis on surgical management.

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Authors and Affiliations

  1. Cardiac Surgery, The Royal Children’s Hospital, Flemington Road, Melbourne, VIC, 3052, Australia

    Johann Brink & Christian Brizard

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  1. Johann Brink
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  2. Christian Brizard
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Correspondence to Christian Brizard .

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Editors and Affiliations

  1. Dept. of Pediatric Cardiology, Children's Hospital Colorado, Univ. of Colorado, Denver, Aurora, Colorado, USA

    Eduardo M. Da Cruz

  2. Dept. Pediatric Cardiology, Children's Hospital Colorado, Univ. of Colorado, Denver, Aurora, Colorado, USA

    Dunbar Ivy

  3. Pediatric Cardiac Surgery, Children's Hospital Colorado, Univ. of Colorado, Denver, Aurora, Colorado, USA

    James Jaggers

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© 2014 Springer-Verlag London

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Brink, J., Brizard, C. (2014). Sub-aortic Stenosis. In: Da Cruz, E., Ivy, D., Jaggers, J. (eds) Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-4619-3_24

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  • DOI: https://doi.org/10.1007/978-1-4471-4619-3_24

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4618-6

  • Online ISBN: 978-1-4471-4619-3

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