Aa
surgery of subaortic membrane
dear sir,your answer would mean a lot to us...
My son ,now 14 yrs,was operated for congenital VSD in 2005. It was a direct closure and was present on the aortic and pulmonary septum.Now in the regular check up the membrane that was first seen as a tag of tissue in 2001,and which caused a gradient of 36m/hg with trivial AR in 2003.Now in the echo this is shown grown termed by the cardiologist as 'kissing the aortic valve' is producing a gradient LVOT of 35m/hg and +1 AR.please advice us about the seriouness of the development.My son otherwise is absolutely normal,does swimming and cycling as any other child.please advice me a course of action.
will await your reply,thank you
My son ,now 14 yrs,was operated for congenital VSD in 2005. It was a direct closure and was present on the aortic and pulmonary septum.Now in the regular check up the membrane that was first seen as a tag of tissue in 2001,and which caused a gradient of 36m/hg with trivial AR in 2003.Now in the echo this is shown grown termed by the cardiologist as 'kissing the aortic valve' is producing a gradient LVOT of 35m/hg and +1 AR.please advice us about the seriouness of the development.My son otherwise is absolutely normal,does swimming and cycling as any other child.please advice me a course of action.
will await your reply,thank you
MEDICAL PROFESSIONAL
Dear Anuishma,
It sounds like your son has what we call subaortic stenosis. This is an obstruction of the left ventricular outflow tract, which is the part of the left ventricle (left-sided pumping chamber) that leads out to the aorta, which then takes blood out to the body. In your son’s case, it appears that the amount of obstruction is likely mild, although without fully evaluating your son, I can’t exactly tell. It also sounds as if there is a very tiny amount of aortic valve regurgitation, or a leak in the aortic valve. The natural history of subaortic stenosis with the formation and growth of these membranes is that they typically do progress over time. The amount of obstruction can get worse, and the turbulence caused by the blood flow across the membrane can damage the aortic valve. This damage can cause the valve to leak more. Based on what you are telling me, it sounds as if the obstruction and the valve leak are both stable, although I would want more information to be able to confirm this. Certainly, the amount of obstruction is not causing a problem for him, as evidence by his amount of physical activity. At this point, I feel that it would be important for him to have routine follow-up evaluations with his cardiologist to make sure that there isn’t progression of either of these problems. If there is, then surgical resection of the membrane may need to be considered.
It sounds like your son has what we call subaortic stenosis. This is an obstruction of the left ventricular outflow tract, which is the part of the left ventricle (left-sided pumping chamber) that leads out to the aorta, which then takes blood out to the body. In your son’s case, it appears that the amount of obstruction is likely mild, although without fully evaluating your son, I can’t exactly tell. It also sounds as if there is a very tiny amount of aortic valve regurgitation, or a leak in the aortic valve. The natural history of subaortic stenosis with the formation and growth of these membranes is that they typically do progress over time. The amount of obstruction can get worse, and the turbulence caused by the blood flow across the membrane can damage the aortic valve. This damage can cause the valve to leak more. Based on what you are telling me, it sounds as if the obstruction and the valve leak are both stable, although I would want more information to be able to confirm this. Certainly, the amount of obstruction is not causing a problem for him, as evidence by his amount of physical activity. At this point, I feel that it would be important for him to have routine follow-up evaluations with his cardiologist to make sure that there isn’t progression of either of these problems. If there is, then surgical resection of the membrane may need to be considered.
I am not a doctor.
From what you have written, it appears that the leakiness of the valve is the same and the obstruction caused by the membrane are the same. So it is the same as it was in 2001, so from what you are telling me, it appears to be stable. The reason why it is +1 AR on one report and trace AR on another report is just that they used 2 different ways of classifying the leakage. Neither system is better than the other, just a matter of personal preference by the doctor.
If it were my child, I would have nothing done except to keep following up with the pediatric cardiologist.
From what you have written, it appears that the leakiness of the valve is the same and the obstruction caused by the membrane are the same. So it is the same as it was in 2001, so from what you are telling me, it appears to be stable. The reason why it is +1 AR on one report and trace AR on another report is just that they used 2 different ways of classifying the leakage. Neither system is better than the other, just a matter of personal preference by the doctor.
If it were my child, I would have nothing done except to keep following up with the pediatric cardiologist.
Dear Echotech,
Last time when we got him operated the docs gave us I month saying that the valve had entered the hole and we were aghast and went with what was their decision.My son also pickup health only after this operation. But this time I do want to do exactly what you are proposing but that is the reason why I'm posting the Question to you all so that I can get the answer from an unbiased and clear brains coz mine is worked up. Thank you for your from the heart opinion I really value it and will follow it to the core.Thanks again
Last time when we got him operated the docs gave us I month saying that the valve had entered the hole and we were aghast and went with what was their decision.My son also pickup health only after this operation. But this time I do want to do exactly what you are proposing but that is the reason why I'm posting the Question to you all so that I can get the answer from an unbiased and clear brains coz mine is worked up. Thank you for your from the heart opinion I really value it and will follow it to the core.Thanks again
MEDICAL PROFESSIONAL
Hi, I think you should post this question in the Pediactric Heart Expert Forum. Good luck to you and your son.
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