Heart Surgery for Sub-Aortic Stenosis by congenital membrane
- drpavankumar
- 0
- on Mar 04, 2020
Heart Surgery for Sub-Aortic Stenosis by congenital membrane
Mrs. D K S is 59 yrs old lady. She complained off & On breathlessness & fainting attacks Since year 2015.during last four years twice she was revived by CPR from fainting attacks. On investigation she was Diagnosed to be having narrowing outflow tract of main pumping chamber left ventricle of her heart few years back by echocardiography . Gradually this narrowing below her hearts aortic valve increased causing more discomfort and blackouts. Recently done Echo suggested that left ventricular out flow obstruction increased to critical level. She underwent cardiac catheterisation which showed actual obstruction level & measurement of gradient across membranous obstruction. Aortic valves were found to be normally functioning with normal coronary arteries. Cardiac MRI done on her showed exact position of sub-Aortic membrane. She underwent open heart surgery at Lilavati Hospital by Dr. Pavan Kumar recently. In the heart surgery subaortic stenotic obstruction was found to be due to membranous structure below aortic valve more below non- coronary cusp area extending as fibrosis on anterior Mitral valve going towards interventricular septum. Membrane with fibrotic band was excised & obstruction was released to open up Left ventricular outflow narrowing. Post resection surgery Aortic valve competency checked & found to be normal. Patient stood operation well.
She had uneventful post operative recovery. Echocardiography showed Left ventricular outflow tract obstruction by membrane disappeared & gradient across out flow tract reduced to less than 25mmHg from 145mmHg before operation. This may be because of hyperbophied Left ventricular muscle in outflow tract which will – further regress in due course of time.
Discussion –This is a rare congenital heart valve disease only 1% of all congenital heart disease suffer from sub-Aortic membrane stenosis. This membrane can be in complete ring form or in patches with diffusely defined thickness of fibro -muscular bands. Aortic valve may or may not be involved . Treatment option is surgical excision by open heart surgery. In this case patient has diagnosis made at age of 55 years & gradually subaortic stenosis increased & due to syncopal attacks she was offered surgery . Aortic valve was found to be normal . Surgical excision of membrane causing subaortic narrowing stenosis has cured the patient of this disease. In less than 5% cases this can recur of surgery is done a less than 10 years age or early childhood. In some cases Aortic Valve is also replaced or left ventricular outflow track hypertrophied muscle excised. Surgical excision is treatment of choice with above 90 % success rate.