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

Abstract

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.

• Authors: Ergin Koçyildirim, Süleyman Ozkan, Demet Karadağ, S Kenan Köse, Enver Ekici, Coşkun Ikizler
• Journal: Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology (Anadolu Kardiyol Derg) Vol. 9 Issue 4 Pg. 311-7 (Aug 2009) ISSN: 1308-0032 [Electronic] Turkey
• PMID: 19666434 (Publication Type: Journal Article)

Topics

• Adolescent
• Animals
• Aorta (surgery)
• Aortic Stenosis, Supravalvular (surgery)
• Cardiac Surgical Procedures (methods)
• Cattle
• Child
• Child, Preschool
• Echocardiography
• Female
• Follow-Up Studies
• Humans
• Magnetic Resonance Imaging
• Male
• Pericardium (transplantation)
• Postoperative Complications (epidemiology)
• Prostheses and Implants
• Plastic Surgery Procedures
• Retrospective Studies
• Treatment Outcome