Left Ventricular-aortic Gradient Research Articles

Effects of Percutaneous Transluminal Septal Myocardial Ablation for Obstructive Hypertrophic Cardiomyopathy on Systolic and Diastolic Left Ventricular Function Assessed by Pressure–Volume Loops

The aim of the present study was to determine the long-term effects of percutaneous transluminal septal myocardial ablation (PTSMA) on systolic and diastolic left ventricular (LV) functions in patients with obstructive hypertrophic cardiomyopathy (HC). Ten consecutive patients with symptomatic HC despite optimal medical treatment were referred for PTSMA at our center. LV systolic and diastolic functions were assessed by online LV pressure-volume loops obtained by conductance catheter at baseline and at 6 months after the procedure. At follow-up, the mean gradients at rest and after extrasystole were significantly decreased compared with baseline (88 +/- 29 to 21 +/- 11 mm Hg and 130 +/- 50 to 35 +/- 22 mm Hg, respectively, p <0.01 for the 2 comparisons). End-systolic and end-diastolic pressures significantly decreased (p <0.01), whereas end-systolic and end-diastolic LV volumes significantly increased (p <0.01 for the 2 comparisons). Cardiac output and stroke volume were unchanged, as were ejection fraction (p = 0.25) and maximum dP/dt (p = 0.13). The slope of the end-systolic pressure-volume relation was not decreased, indicating a preserved contractility. The relaxation constant time, end-diastolic stiffness, projected volume of the end-diastolic pressure-volume relation at 30 mm Hg, and diastolic stiffness constant showed a significant improvement of active and passive myocardial diastolic properties. In conclusion, PTSMA is an effective method in the treatment of symptomatic patients with HC. At 6-month follow-up, the LV-aortic gradient was decreased and active and passive LV diastolic properties were increased. Myocardial contractility was not decreased and general hemodynamics was maintained.

Surgery for aortic stenosis in children: a 40-year experience

Background Aortic stenosis (AS) is encountered in approximately 5% of children with heart disease. The indications for surgery and the surgical techniques for AS are well established. This report focuses on the early and long-term outcomes in children with AS over a 40-year period. Methods Included in this study were 508 patients ranging in ages from 1 day to 19 years, who were operated on for AS between 1960 and 2002 . Eighty-one percent (414 of 508) of the patients had left ventricular outflow tract obstruction (LVOTO) at a single level: 40 supravalvar, 242 valvar (critical AS in 85 neonates and young infants and in 157 older children), and 132 subvalvar. Nineteen percent (94 of 508) of the patients had LVOTO at more than one level. Associated congenital cardiac defects were found in 32% of the patients. Results The overall hospital mortality rate was 8% (40/508) with neonates with critical AS having the highest mortality (33%). The late mortality was 4% for the entire group. Follow-up was 95% complete. The mean follow-up was 8.5 ± 7.1 years. In the subgroup with multilevel LVOTO (n = 94), the average intraoperative peak systolic left ventricular-aortic gradient decreased from 80 to 22 mm Hg after repair but increased progressively to 74 ± 36 mm Hg ( p < 0.05) before reintervention was required. One hundred twenty-one patients (24%) underwent 151 reoperations for recurrent or residual LVOTO or aortic regurgitation. Actuarial curves predict a 20-year survival of 88% and 62% freedom from reoperation for all patients with AS. Symptomatic improvement in survivors was excellent (90% New York Heart Association class I). Conclusions Surgical relief of LVOTO in infants and children can be accomplished with low mortality and morbidity. Neonates with critical AS have significantly higher mortality and morbidity due to their complex anatomy and their critical presentation that affects outcome. Aortic valvotomy delays valve replacement in a significant percentage of children. The Ross procedure and mechanical aortic valve replacements have had a low mortality and morbidity in our series. Valve replacement will eventually be required in most children presenting with valvar AS and multilevel LVOTO while repair of discrete subaortic stenosis and supravalvar AS may not require reoperation in most patients. Children with LVOTO should have lifetime follow-up.

Surgical Experience with Doty's Repair for Supravalvular Aortic Stenosis

The surgical treatment of severe supravalvular aortic stenosis by conventional, asymmetrical, one point patch aortoplasty across the narrowed area has been associated with a substantial incidence of residual stenosis and reoperations. Almost symmetrical relief of such stenosis was achieved with Doty's extended aortoplasty in 5 patients in whom left ventricular aortic gradient was reduced from 60–170 nun Hg to 0–25 mm Hg. This technique of inserting an inverted V-shaped gusset across the stenosed segment into the right coronary sinus and non-coronary sinus, restores the aortic root geometry, provides more predictable relief of aortic obstruction and also improves aortic valve function. Associated procedures involved relief of coarctation of aorta and innominate artery stenosis in 1 case and repair of aortic valve and mitral valve in another case.

Neonatal aortic stenosis

Aortic stenosis in the neonate has been associated in the past with a high operative mortality. As a result, in the current era of percutaneous balloon dilatation, the optimal mode of therapy remains controversial. An approach of stabilization with cardiopulmonary bypass, followed by relief of left ventricular outflow tract obstruction, was used at three institutions, and the results are presented. During the period 1983 to 1989, 40 neonates with isolated aortic stenosis and patent ductus arteriosus or coarctation of the aorta, or both, underwent operative therapy. Ages ranged from 1 to 30 days, median of 12 days, including 17 patients in the first week of life. There were 30 boys and 10 girls; weights ranged from 2.5 to 5.5 kg with a mean of 3.6 kg. Perioperative conditions included congestive heart failure in 38 and mitral regurgitation in 16; left ventricular-aortic gradients ranged from 15 to 130 mm Hg, with a mean of 67 mm Hg. There were 30 open valvotomies and 10 transventricular dilatations. The hospital survival rate was 87.5% (35/40) with no significant difference between the methods of valvotomy (9/10 in the transventricular dilatation group, 90%; 26/30 in the open valvotomy group, 87%). Although multiple methods of perfusion and valvotomy were used, the single unifying factor of cardiopulmonary bypass stabilization was present in all 40 patients. No significant difference in survival was noted between institutions, methods of cardiopulmonary bypass, cardiopulmonary bypass times, crossclamp times, or method of valvotomy. There have been five reoperations, with one late death in a patient requiring mitral valve replacement and an apical-aortic conduit. One sudden death occurred; autopsy revealed endocardial fibroelastosis. Results demonstrate that in the three institutions using the methods described, a high operative and late survival rate is possible. The results of this technique, against which percutaneous dilatation should be compared, are standard in the current era.

“Acquired” discrete subvalvular aortic stenosis: Natural history and hemodynamics

Discrete subvalvular aortic stenosis is a progressive lesion. Most reported cases have had a measurable left ventricular. aortic gradient that progressed in severity. This report describes 35 patients in whom no significant left ventricular-aortic obstruction was noted at initial cardiac catheterization, but who later were shown to have significant subvalvular aortic stenosis. In 24 of the 35 cases, absence of a significant left ventricular-aortic gradient (≤10 mm Hg) was documented at initial cardiac catheterization. In 11 patients, a left ventricular-aortic pressure gradient was not obtained or not sought in the absence of clinical evidence of an obstructive lesion. In each case, discrete subaortic stenosis was not noted on angiography.Associated lesions included ventricular septal defect in 7, patent ductus arteriosus in 12, coarctation of the aorta in 8, pulmonary stenosis in 3, atrioventricular canal in 2 and miscellaneous lesions in 3 cases. The 35 patients had documentation of subvalvular aortic stenosis 3 months to 19 years after their initial study based on repeat catheterizations in 26, echocardiography in 6 or discovery at surgery in 3 cases. There were eight children with coarctation and no left ventricular-aortic gradient who developed significant subvalvular stenosis at a median of 2 years 9 months after initial cardiac catheterization. Of 30 patients with associated lesions, 23 had surgical intervention before development of subvalvular aortic stenosis, but only 5 of 17 patients with ventricular septal defect had surgical repair or palliation specifically for the interventricular communication before development of subvalvular aortic stenosis. Thirty patients required surgery for subvalvular obstruction at a median of 7.7 years after initial catheterization.It is concluded that discrete subvalvular aortic stenosis may develop despite prior documentation of no left ventricular-aortic gradient. Although subvalvular aortic stenosis may have a preexisting substrate, the lesion can present as an “acquired” disease with progressive hemodynamic severity.

Extended Aortoplasty to Relieve Supravalvular Aortic Stenosis

An extended aortoplasty was used to relieve severe supravalvular aortic stenosis in 5 patients whose preoperative left ventricular-aortic gradient ranged from 85 to 140 mm Hg (median, 120 mm Hg). The stenotic ring above the commissures was divided in two places by an inverted U incision extending into the right and noncoronary sinuses. A distal vertical incision in the ascending aorta converted this into an inverted Y. The ridge above the left coronary sinus was excised. The aortic incision was repaired with an inverted Y-shaped Dacron gusset. The postoperative gradient ranged from 0 to 30 mm Hg (median, 15 mm Hg). The extended aortoplasty provides excellent relief of supravalvular aortic stenosis and, in addition, restores the aortic root geometry to a much more anatomical configuration than is achieved with the simple patch technique.

The perioperative fate of residual gradients after repair of discrete subaortic stenosis and time-related blood levels of catecholamines

The fate of the residual peak systolic left ventricular-aortic gradient was studied perioperatively in 14 patients with membranous discrete subaortic stenosis. In nine (group A) the initial postrepair left ventricular-aortic gradient was greater than 35 mm Hg (mean 56.8 +/- 13.4), and in five (group B) there was no significant postoperative gradient (mean 15.3 +/- 3.2 mm Hg). The operation included membranectomy and myectomy. Peak left ventricular-aortic pressure gradient, endogenous levels of norepinephrine, peak rate of rise of left ventricular pressure, cardiac index, systemic vascular resistance, heart rate, and central venous pressure were recorded at the end of cardiopulmonary bypass and in 3-hour intervals for the next 9 hours. In group A during that period there was a 67% reduction in peak systolic left ventricular-aortic gradient (from 56.8 +/- 13.4 to 18 +/- 14 mm Hg, p less than 0.001). Concomitant reduction in the initial endogenous norepinephrine level was observed (from 982.1 +/- 181 to 422.6 +/- 109 pg/ml, p less than 0.001). A consistent linear relationship between norepinephrine levels and peak systolic left ventricular-aortic gradient was found (r = 0.78). Systolic left ventricular pressure decreased from 174.2 +/- 24.8 to 113.8 +/- 14.7 mm Hg (p less than 0.001). Marked reduction in peak rate of rise of left ventricular pressure (from 3455 +/- 636 to 2161 +/- 680 mm Hg/sec, p less than 0.001) was observed. Cardiac index increased and systemic vascular resistance decreased during the study period (from 2.11 +/- 0.2 to 3.07 +/- 0.26 L/min, p less than 0.001, and from 2172 +/- 331 to 1233 +/- 202 dynes/sec/cm-5, p less than 0.001, respectively). There were no significant changes in heart rate (p = not significant) and central venous pressure p = not significant). Some of the residual perioperative left ventricular-aortic gradients in patients with discrete subaortic stenosis undergoing repairs are dynamic and transient, and are probably related to increased postoperative sympathetic activity.

Surgical spectrum of aortic stenosis in children: A thirty-year experience with 257 children

Aortic stenosis accounts for 5 to 6% of infants and children seen for surgical repair of congenital heart disease. The clinical presentation and reported results of operation for aortic stenosis are highly variable. This retrospective review was undertaken to assess our operative mortality and the degree of gradient reduction afforded by each of several surgical techniques used to treat aortic stenosis in children over a 30-year period. Two hundred fifty-seven patients ranging in age from 1 day to 19 years were operated on between 1957 and 1986. The indication for operation included asymptomatic patients with gradients greater than 50 mm Hg to patients in profound cardiogenic shock. The operative mortality for children older than 6 months was 4%, whereas neonates seen with critical aortic stenosis had a 60% mortality. The late mortality was 2%. Eighty percent of surviving patients to date have undergone cardiac catheterization after repair. This shows an overall reduction of 57 mm Hg in the left ventricular-aortic gradient. Patients with supravalvular aortic stenosis and discrete subvalvular aortic stenosis as well as patients undergoing aortic valve replacement showed a reduction in or elimination of associated aortic insufficiency, whereas patients undergoing aortic valvotomy or neonates having valvotomy had a significant increase in demonstrable aortic insufficiency. The incidence of third-degree heart block or cerebral emboli following operation for aortic stenosis was less than 1%. However, the incidence of late bacterial endocarditis following repair was nearly 5%; six of eleven cases occurred in the group with discrete subvalvular aortic stenosis. Twenty-nine (13%) of the 223 long-term survivors have undergone a subsequent procedure for relief of residual or recurrent obstruction; 12 have had insertion of an aortic valve prosthesis, 12 have had insertion of an apicoaortic conduit, and 6 have required repeat aortic valvotomy. These data demonstrate the low operative mortality and excellent hemodynamic benefit of surgical relief of single-level aortic stenosis in children older than neonates. Conduits placed for complex obstructions or operative procedures in neonates have acceptable hemodynamics benefits, but operative mortality remains high.

Intermediate and late follow-up of the use of apico-aortic conduits in the surgical treatment of hypertrophic cardiomyopathy

Between December 1977 and July 1983, four apico-aortic prosthetic valved conduits were implanted in four patients affected by severe hypertrophic cardiomyopathy. The disease was isolated in two cases, associated with critical stenosis of the right coronary artery in one case and with a subaortic tunnel plus aortic valve regurgitation in the final case. Three patients were male and one female; the ages ranged from 6 to 49 years. All patients survived surgery and were followed-up. At present, all are living and have no postoperative symptoms. The left ventricular-aortic gradient was relieved in all cases. Echocardiographic studies during the follow-up showed an enlargement of the left ventricular cavity with a satisfactory cardiac contraction. Three years following surgery the female patient gave birth to a normal male baby. Her pregnancy was normal and without complications. Seven years after surgery the first patient was successfully reoperated because of conduit thrombosis caused by degeneration of the biological porcine valve. In the follow-up, which ranges from 18 months to 7 years (mean 4.5 years) all patients are in Functional Class I. All preoperative symptoms have been relieved for all patients and there has been no incidence of late or sudden death.

Surgery for Discrete Subvalvular Aortic Stenosis: Actuarial Survival, Hemodynamic Results, and Acquired Aortic Regurgitation

Discrete membranous subaortic stenosis (DMSS) accounts for 8 to 30% of congenital left ventricular outflow obstruction. The immediate effectiveness of surgical resection of this discrete obstructing membrane has been well documented, but little has appeared regarding late clinical and hemodynamic follow-up. Fifty-three patients with DMSS underwent operation at our institution from 1957 to 1983. Most (78%) were symptomatic, 79% had left ventricular hypertrophy (LVH) by electrocardiogram, and 92% had roentgenographic evidence of cardiomegaly preoperatively. Catheterization revealed a mean preoperative left ventricular-aortic gradient of 89 mm Hg. Twenty-eight patients had associated aortic insufficiency (AI) on the initial aortogram. Seven patients acquired AI in the interim between the first and second preoperative catheterization. Our patients have been followed for up to 12 years postoperatively. There have been 2 early and 3 late deaths. (Actuarial analysis revealed 5- and 10-year survival of 95% and 83%, respectively.) Seventy-one percent of the previously symptomatic patients noted relief of their preoperative complaints, and 45% of those with LVH had a regression in voltage. Cardiomegaly as determined by chest roentgenogram decreased in 45%. The left ventricular-aortic gradient fell to an average of 35 mm Hg a year postoperatively. Surgical treatment of congenital subvalvular aortic stenosis is effective in reducing the preoperative symptoms and the left ventricular-aortic gradient. It appears that DMSS causes AI.

Regression of myocardial hypertrophy: III. Alterations in left ventricular performance

Parameters of left ventricular function were measured during the regression of pressure-overload induced left ventricular hypertrophy. Supravalvar aortic stenosis was produced in rats by constricting their ascending aorta with a metal band. Sham operated rats served as controls. Four weeks after constriction the bands were removed from a group of rats. Other rats with aortic constriction and sham operated controls underwent a sham operation. Two, 4 or 8 weeks later rats from each group underwent a hemodynamic study in situ. The left ventricular-aortic gradient was completely abolished upon removal of the band. Left ventricular weight rapidly decreased toward that of the sham operated control within the first 2 weeks. Cardiac output and stroke volume were similar in the control and banded animals. However, in the debanded animals both parameters fell below the levels of the sham operated control rats and the rats with continued aortic constriction by 2 weeks. By 8 weeks cardiac output and stroke volume in these rats returned to normal. Peak flow velocity was decreased in both the banded and the debanded rats, but returned to control levels by four weeks after debanding. The data suggest that although a normal cardiac output can be maintained by the hypertrophied, pressure-overloaded myocardium, myocardial pump function diminishes during the early regression of hypertrophy coinciding with the loss of myocardium. Function does recover, however, after a longer period of regression. This phenomenon may be related to an abnormality in the hypertrophied myocardial muscle and to the decreased synthesis of myocardial muscle previously demonstrated during the regression of hypertrophy.

Coronary flow studies in patients with left ventricular hypertrophy of the hypertensive type: Evidence for an impaired coronary vascular reserve

Increased myocardial blood flow occurs in ventricular hypertrophy, but flow per 100 grams of myocardium remains normal. The increase in flow may be obtained at the expense of the existing coronary vascular reserve or by an increase in the vascular bed. The coronary vascular reserve was studied by analyzing the hyperemic reaction to selective injection of contrast agent into the coronary arteries in 25 patients: a control group (9 patients) with chest pain syndrome, normal coronary arteries and a normal left ventricle (Group I) and 16 patients with aortic stenosis, left ventricular hypertrophy and normal coronary arteries (Group II). The hyperemic response in Groups I and II was 73.3 ± 2.2 and 65.8 ± 9.1 percent, respectively (difference not significant). Group II was subdivided into two groups: Group IIA had five patients with a left ventricular mass of less than 200 g (mean 158.8 ± 25.9); this group had a hyperemic response of 102.3 ± 9.9 percent. Group IIB had 11 patients with a left ventricular mass of more than 200 g (mean 308.9 ± 22.5) and a hyperemic response of 49.27 ± 10.42 percent. The hyperemic response was correlated with the diastolic left ventricular-aortic gradient (r = +0.64, p < 0.001), left ventricular mass (r = −0.51, p < 0.01) and aortic diastolic pressure (r = +0.636, p < 0.001). Group I had a left ventricular mass similar to that of Group IIA (124.9 ± 9 and 158.8 ± 26 g, respectively) but a lower hyperemic response (73.3 ± 2 and 102.3 ± 10 percent, respectively). These data suggest that severe left ventricular hypertrophy is associated with a reduction in coronary vascular reserve; it is speculated that this decrease in the vascular reserve capacity may be related to the ischemie component of hypertrophic heart disease.

Rest and exercise hemodynamics in children before and after aortic valvotomy

The rest and exercise hemodynamics in children with congenital valvar aortic stenosis were studied before and after aortic valvotomy. Eighteen patients were studied at rest; ten of the 18 patients were also studied during supine leg exercise using a bicycle ergometer. Aortic valvotomy resulted in a significant reduction in the mean left ventricular-aortic pressure gradient and in peak left ventricular systolic pressure with an increase in aortic valve area in most patients. There was an associated increase in the subendocardial blood flow assessed indirectly by the DPTI × O 2 c SPTI ratio. There was a minor increase in the degree of aortic insufficiency in most patients. Although, in general, there was significant hemodynamic improvement, three of the 18 patients still had significant residual stenosis after surgery and another four patients had a major increase in aortic insufficiency. The three patients with residual obstruction and one of the four patients with moderate to severe aortic insufficiency still had a DPTI × O 2 c SPTI ratio of less than 10, suggesting possible residual subendocardial ischemia. Also, the increased left ventricular end-diastolic pressures (LVEDP) present in nearly 50% of the patients before surgery did not change significantly after surgery. Three patients showed an actual increase in LVEDP after surgery. Before surgery, the left ventricular systolic pressure and mean gradient increased on exercise, but this increase was proportionately less than the increase in cardiac output, so that calculated aortic valve area increased on exercise. The DPTI × O 2 c SPTI ratio decreased significantly on exercise, suggesting an increase in myocardial ischemia. Successful surgery resulted in a reduction in left ventricular systolic pressure and mean left ventricular-aortic gradient on exercise, and in improvement in the subendocardial blood flow as assessed by the DPTI × O 2 c SPTI ratio. In general, children with severe aortic stenosis have relatively normal cardiac function on exercise. Some children did show a reduction of stroke index on exercise in spite of rising LVEDP. However, stroke work index increased in all of our children. Adult studies have shown many patients with decrease in stroke work index relative to LVEDP on exercise. The results of pre- and postoperative rest and exercise hemodynamics may be useful in evaluating results of surgery; the postoperative hemodynamic evaluation including the use of DPTI × O 2 c SPTI ratio provides additional useful information which can be used in making decisions concerning exercise activity after surgery.

Progression of Aortic Stenosis

We assessed progressive stenosis of the aortic valve in 11 adult patients (mean age of 48 years) with aortic stenosis who had undergone two cardiac catheterizations without intervening aortic valve surgery. The mean time between cardiac catheterization was 59 months (range 20 to 133). No patients had mitral valve disease. Two patients had coronary artery disease. The results showed that progressive stenosis of the aortic valve occurred in 10 of 11 patients with a significant decrease in the calculated mean aortic valve area from 1.2 +/- 0.2 sq cm to 0.7 +/- 0.1 sq cm (P less than 0.005); a significant increase in mean left ventricular peak systolic pressure from 149 +/- 8 mm Hg to 199 +/- 3 mm Hg (P less than 0.01), and a significant increase in mean left ventricular aortic pressure gradient from 31 +/- 4 mm Hg to 75 +/- 13 mm Hg (P less than 0.005). On an individual basis, the change in left ventricular pressure and the left ventricular-aortic gradient did not always reflect the decrease in aortic valve area because of variations in cardiac output. The shortest period of time in which progression of aortic stenosis occurred was 27 to 29 months. Thus, progressive stenosis of the aortic valve occurs in adults with isolated aortic valvular stenosis. Significant decrease in the aortic valve area can develop in as short a period as 27 to 29 months.

Left ventricular function by echocardiography in children with fixed aortic stenosis

Left ventricular function was evaluated echocardiographically within 24 hours of cardiac catheterization in 45 children with fixed aortic stenosis. Left ventricular systolic time intervals, mean velocity of circumferential fiber shortening, left ventricular end-diastolic volume and shortening fraction were evaluated. Some patients with severe aortic stenosis had a shortened preejection period, prolonged ejection time and increased mean velocity of circumferential fiber shortening in comparison with normal subjects, but these findings were not consistent within the group with severe aortic stenosis or apparent in patients with mild or moderate aortic stenosis. Left ventricular end-diastolic volume was smaller in children with severe obstruction than in normal children. Evaluation of the shortening fraction provided good separation of patients with significant obstruction from those with mild disease. Further, there was a linear correlation between the shortening fraction and the left ventricular-aortic gradient demonstrated at cardiac catheterization. This correlation was also of use in evaluating the response of patients to surgical relief of obstruction. Pre- and postoperative echocardiographic evaluation of the shortening fraction appears to provide a readily available noninvasive method of assessing the course and severity of obstruction in fixed aortic stenosis in children.

Congenital aortic stenosis: Experience with 43 patients

Between September, 1967, and January, 1975, 43 patients underwent intracardiac repair for congenital aortic stenosis at the Buffalo Children's Hospital. The patients ranged in age from 2 days to 24 years, 6 of them being below one year of age. Valvular aortic stenosis was found in 21 cases (4 infants [Group I-A] and 17 older patients [Group I-B]), discrete subaortic membranous diaphragm in 11 (Group II); diffuse subvalvular muscular obstruction in 3 (Group III), supravalvular stenosis in 4 (Group IV), and multiple-level obstruction in 4 (2 infants [Group V-A] and 2 older patients [Group V-B]). Preoperatively, 58 per cent of the patients were symptomatic and 67 per cent had abnormal electrocardiograms. Associated congenital cardiac defects were found in 28 per cent of the cases. The over-all hospital mortality rate was 9 per cent (3 patients in Group I-A and one in Group V-A), with no deaths occurring in patients older than 3 months of age at the time of operation. Two late deaths occurred (Groups I-B and V-B). A complete heart block developed in one patient (Group III). The average intraoperative peak systolic left ventricular-aortic gradient decreased in all groups after repair but progressively increased in the late hemodynamic studies obtained in symptomatic patients. Six patients were reoperated upon for recurrent obstruction. Late results were evaluated on the basis of symptoms, electrocardiographic findings, valve function, and hemodynamic data. They showed excellent or satisfactory results in 59 per cent of the patients in Group I-B, in 45 per cent in Group II, in 66 per cent in Group III, and in 25 per cent in Group I-V. Results were fair or poor in Groups, I-A, V-A, and V-B. In children and adolescents, effective relief of the obstruction and of the symptoms can be obtained with minimal operative risk and minimal morbidity. In symptomatic infants, despite the high operative mortality rate, surgical intervention is indicated because of the poor prognosis.

The Natural History of Mild Congenital Aortic Stenosis in Patients Studied by Serial Left Heart Catheterization.

s1 May 1968The Natural History of Mild Congenital Aortic Stenosis in Patients Studied by Serial Left Heart Catheterization.Lawrence Sanford Cohen, M.D., Eugene Braunwald, M.D., F.A.C.P., John Ross Jr., M.D., F.A.C.P., Andrew G. Morrow, M.D., F.A.C.P.Lawrence Sanford Cohen, M.D.Search for more papers by this author, Eugene Braunwald, M.D., F.A.C.P.Search for more papers by this author, John Ross Jr., M.D., F.A.C.P.Search for more papers by this author, Andrew G. Morrow, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-68-5-1152_4 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAn important unanswered question concerning the natural history of congenital aortic stenosis is whether mild obstruction in asymptomatic children progresses to severe obstruction in later life. Eighteen patients with congenital aortic stenosis found to have mild to moderate obstruction at left heart catheterization when first studied between 1957 and 1962 were recalled for study in 1967. One patient had died suddenly. In six patients a significant increase in the degree of obstruction to left ventricular outflow was found, that is, the left ventricular-aortic gradient increased by more than 30 mm Hg, or the outflow orifice area declined to below 0.6... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Bethesda, Maryland PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySerial hemodynamic observations in congenital valvular and subvalvular aortic stenosisSerial Hemodynamic Observations in Asymptomatic Children with Valvar Aortic Stenosis 1 May 1968Volume 68, Issue 5Page: 1152-1153KeywordsCatheterizationChildrenHeartLongitudinal studiesStenosis Issue Published: 1 May 1968 PDF downloadLoading ...

FUNCTIONAL SUBAORTIC STENOSIS

Excerpt Advances in cardiovascular surgery have naturally stimulated a reevaluation of valvular lesions which may be amenable to surgical correction. Although subaortic stenosis of the left ventric...