Discrete supravalvular aortic stenosis in children: Is it necessary to reconstruct the whole aortic root?

Koçyildirim E., Öskan S., Karadaǧ D., KÖSE S. K., Ekici E., Ikizler C.

Anadolu Kardiyoloji Dergisi, cilt.9, sa.4, ss.311-317, 2009 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 9 Sayı: 4
  • Basım Tarihi: 2009
  • Dergi Adı: Anadolu Kardiyoloji Dergisi
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.311-317
  • Anahtar Kelimeler: Discrete supravalvar aortic stenosis, Left ventricular outflow tract obstruction, Surgical procedures
  • Ankara Üniversitesi Adresli: Evet

Özet

Objective: Discrete supravalvular aortic stenosis (SAS) is known to involve the whole aortic root. Some surgeons have therefore changed their approach from relief of obstruction using a single-patch to symmetric reconstruction of the whole aortic root - three-patch technique. The advantages are said to be preserved long-term aortic valve function and allowance for growth. This is unproven. We compare growth and aortic root geometry in patients who have undergone relief of discrete SAS using either single-or three-patch technique. Methods: Twenty-five patients (14 male, 11 female, mean age of 11± 4 years, range 4-18) underwent surgery for discrete SAS. No patients with diffuse SAS were included in this retrospective analysis. Twelve patients had features of Williams syndrome. Five patients had other concomitant procedures. A single-patch was inserted into the longitudinal incision, which passed across the stenosis into the non-coronary sinus in 14. A three-patch technique was used in 11 patients. Changes in aortic root following repair were documented in patients using both echocardiography and magnetic resonance imaging (MRI). Results: There were no operative deaths. The mean preoperative gradient was 66±17 mmHg (range 50-100 mmHg), which decreased to 14±7 mmHg (range 4-18 mmHg) early postoperatively. The late mean gradient was 15±5 mmHg. There was no significant difference in the incidence of postoperative aortic regurgitation or gradient across the repair between two techniques according to the echocardiograms and MRI findings. Conclusion: According to our study, we cannot demonstrate any benefit in reconstructing the whole aortic root for discrete SAS. A single-patch technique is easy, safe and appears durable. © Copyright 2009 by AVES Yayincilik Ltd.