Discrete Subaortic Stenosis: Surgical Outcome (2016-2022)

  • Kassem Mohammed Zaier MBChB, FICMS
  • Amjed Abdulridha Ahmed Alhilo MBChB, FICMS
  • Jalal Jaafar Abdulhussein
Keywords: Associated anomalies, Aortic valve regurgitation, Subaortic stenosis Tachyarrhythmia, Reoperation


Background:        Discrete subaortic stenosis is a dynamic and presumably gained cardiac anomaly in which the left ventricular outflow tract is impeded by a subvalvular fibromucular band. This condition may occur as an isolated defect or be associated with other anomalies. Discrete subaortic stenosis remains a surgical challenge for the comparatively high prevalence of relapse of stenosis or evolution to aortic regurgitation. Objective:         To review surgical outcome in discrete subaortic stenosis and evaluate of additional risk of associated anomalies in surgical outcome. Methods:        Thirty-seven patients (16 males and 21 females) underwent surgical resection of subaortic membrane. Their data were collected and retrospectively studied from 1st of January 1999 to 1st of November 2017 at Ibn-Alnafees Teaching hospital for cardiothoracic surgery in Baghdad, Iraq. We divided the patients into two groups, group A: included eight patients who had isolated subaortic membrane and group B: included 29 patients who had associated anomalies. A comparison was made between the two groups according to preoperative variables and postoperative morbidity and mortality. Results:        Postoperative mitral valve injury, iatrogenic ventricular septal defect,residual subaortic stenosis and aortic valve injury were not observed in any patient. Post-operative complete heart blockwasseen in one patient only belong to group B (3.45%). Tachyarrhythmia post repair was founded intwo patients in group B (6.89%) versus no any patient in group A. There was no operative death, the mortality was (0%) in both groups. Conclusion:        Surgical outcome of resection subaortic membrane is excellent in early term with low morbidity and mortality whether it was isolated lesion or associated with other anomalies.


- Drolet C, Miro J, Cote JM, Finley J, Gardin L, Rohlicek CV. Long-term pediatric outcome of isolated discrete subaortic stenosis. Can J Cardiol 2011; 27(3): 389e 19e.24.

- Uysal F, Bostan OM, Signak IS, Semize lE, Cil E. Evaluation of subvalvular aortic stenosis in children:a16-year single center experience. Pediatr Cardiol 2013; 34(6): 1409-14.

-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: 23-5.

- Oliver JM, González A, Gallego P, et al. Discrete subaortic stenosis in adults: increased prevalence and slow rate of progression of the obstruction and aortic regurgitation. J Am Coll Cardiol 2001; 38(3): 835.

- Van der Linde D, Takkenberg JJ, Rizopoulos D, et al. Natural history of discrete subaortic stenosis in adults: a multicenter study. Eur Heart J 2013; 34(21):1548-56.

- Anderson BR, Tingo JE, Glickstein JS, et al. When is it better to wait? Surgical timing and recurrence risk for children undergoing repair of subaortic stenosis. Pediatr Cardiol 2017; 38(6):1106.

- Pickard SS, Geva A, Gauvreau K, et al. Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children. Heart 2015; 101:1547.

- Van der Linde D, Roos-Hesselink JW, Rizopoulos D, et al. Surgical outcome of discrete subaortic stenosis in adults: a multicenter study. Circulation 2013; 127:1184.

- Lopes R, Lourenco P, Goncalves A, Cruz C, Maciel MJ. The natural history of congenital subaortic stenosis. Cong Heart Dis 2011; 6(5): 417-23.

- Foker JE.Outcomes and questions about discrete subaortic stenosis. Circulation 2013;127(14):1447-50.

- Karamlou T, Gurofsky R, Bojcevski A, et al. Prevalence and associated risk factors for intervention in 313 children with subaortic stenosis. Ann Thorac Surg 2007; 84: 900.

- Dodge Khatami A, Schmid M, Rousson V, Fasnacht M, Doell C, Bauersfeld U, et al. Risk factors for reoperation after relief of congenital subaortic stenosis. Eur J Cardiothorac Surg 2008;33(5):885-9.

-Jou CJ, Etheridge SP, Minich LL, et al. Long-term outcome and risk of heart block after surgical treatment of subaortic stenosis. World J Pediatr Congenit Heart Surg 2010; 1:15.

- Geva A, McMahon CJ, Gauvreau K, et al. Risk factors for reoperation after repair of discrete subaortic stenosis in children. J Am Coll Cardiol 2007; 50:1498.

- P. Stassano, L. Di Tommaso, A. Contaldo, M. Monaco, M. Mottola, A. Musumeci, et al. Discrete subaortic stenosis: long-term prognosis on the progression of the obstruction and of the aortic insufficiency. Thorac Cardiovasc Surg 2005; 53: 23-27.

- Hirata Y, Chen JM, Quaegebeur JM, Mosca RS. The role of enucleation with or without septal myectomy for discrete subaortic stenosis. J Thorac Cardiovasc Surg 2009;137(5):1172.

Darcin Osman , and colleagues , Discrete Subaortic Stenosis Surgical Outcomes and Follow-Up Results , Texas Heart Institute Journal , Volume 30, Number 4, 2003:286.