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Subaortic stenosis in the spectrum of atrioventricular septal defects

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Presentation on theme: "Subaortic stenosis in the spectrum of atrioventricular septal defects"— Presentation transcript:

1 Subaortic stenosis in the spectrum of atrioventricular septal defects
Glen S. Van Arsdell, MDa(by invitation), William G. Williams, MDa, Christine Boutin, MDb(by invitation), George A. Trusler, MDa, John G. Coles, MDa, Ivan M. Rebeyka, MDa(by invitation), Robert M. Freedom, MDb, c(by invitation)  The Journal of Thoracic and Cardiovascular Surgery  Volume 110, Issue 5, Pages (November 1995) DOI: /S (95) Copyright © 1995 Mosby, Inc. Terms and Conditions

2 Fig. 1 Actuarial freedom from reoperation in patients with subaortic stenosis plus AVSD. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

3 Fig. 2 Left, Wide angle between the plane of the outlet septum and the crest of the septum (outflow angle) in a normal heart. Right, Narrow angle in a heart with AVSD. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

4 Fig. 3 Mild enlargement of the outflow angle with myectomy. The LVOT remains narrow and long. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

5 Fig. 4 Left AV valve leaflet augmentation and lifting of the superior bridging leaflet. The superior bridging leaflet is detached from the anterior portion of the septal crest extending to the region just to the left of the LVOT. The increased mitral aortic separation is excised. A pericardial patch augments the leaflet andcloses the VSD (if present). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

6 Fig. 5 Addition of myectomy to leaflet augmentation widens the outflow angle to near normal. This effectively shortens and widens the LVOT. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

7 Fig. 6 Creation of an infundibular VSD with a patch from the right ventricular side widens the outflow angle but does not alter the inlet anatomy. This leaves a long LVOT. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

8 Fig. 7 The outflow angle is wide in Rastelli type Clesions, which may explain the low incidence of subaortic stenosis. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (95) ) Copyright © 1995 Mosby, Inc. Terms and Conditions

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