During a mean follow-up of 6.5 years, 81% of patients with mild discrete subaortic stenosis developed complications such as aortic insufficiency, endocarditis, or increased pressure gradients.
Observational (n=21)
Mild discrete subaortic stenosis is a progressive condition often leading to increased outflow gradients, aortic insufficiency, or endocarditis, warranting close follow-up and consideration for earlier surgical intervention.
We report 21 patients with discrete subaortic stenosis (DSS) causing mild obstruction with a peak systolic left ventricular outflow pressure gradients less than 50 mm Hg. They were followed 1--17 years (mean 6.5 years), and eight were recatheterized before surgery, 2--17 years after the first cardiac catheterization. Three patients (14%) had subacute bacterial endocarditis. Ten (48%) had aortic insufficiency, one of whom had no pressure gradient across the left ventricular outflow tract. In three of the 10 patients, aortic insufficiency was found only at the second catheterization. Nine patients (43%) had hyperactive, asymmetric left ventricular contraction; in three, this finding was present only at the second catheterization. Seven of the eight patients who were recatheterized (33% of the entire group) showed an increase in gradient. The increase was from a mean gradient of 35.2 mm Hg to 76.7 mm Hg. Seventeen patients (81%) had at least one of these four features. In view of these data, we suggest that surgical indications for DSS might be expanded, although definitive recommendations are not possible. All cases of DSS should be carefully followed. Surgery should be performed if signs of progressive complications develop.
Shem-Tov et al. (Wed,) conducted a observational in Mild discrete subaortic stenosis (n=21). Mild discrete subaortic stenosis was evaluated on Development of at least one of four features: subacute bacterial endocarditis, aortic insufficiency, hyperactive asymmetric left ventricular contraction, or increase in gradient. During a mean follow-up of 6.5 years, 81% of patients with mild discrete subaortic stenosis developed complications such as aortic insufficiency, endocarditis, or increased pressure gradients.