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J Thorac Cardiovasc Surg 2007;133:196-203
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Geometry of the left ventricular outflow tract in fixed subaortic stenosis and intact ventricular septum: An echocardiographic study in children and adults

^a Department of Pediatrics, Royal Brompton Hospital and Imperial College, London, United Kingdom
^b Department of Cardiology/Echocardiography, Royal Brompton Hospital and Imperial College, London, United Kingdom
^c Department of Cardiothoracic Surgery, Royal Brompton Hospital and Imperial College, London, United Kingdom.

Received for publication June 8, 2006; revisions received August 3, 2006; accepted for publication September 11, 2006.

^_* Reprint requests: Reza Barkhordarian, MBBS, MRCS, Department of Paediatrics, Cardiac Morphology Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. (Email: r.barkhordarian{at}imperial.ac.uk).

OBJECTIVE: We compared the echocardiographic geometry of the preoperative and postoperative left ventricular outflow tract in children and adults with isolated fixed subaortic stenosis with age- and weight-matched controls to elucidate whether the geometry can be modified when surgical intervention is performed at a younger age.

METHODS: The mitral–aortic valve distance, aortic valve diameter, aorto–left ventricular septal angle, degree of aortic valve dextroposition, aortic valve–subaortic stenosis distance, width of left ventricular outflow tract, left ventricle wall thickness, and septal thickness were determined preoperatively and postoperatively in 21 patients and 21 controls. The measurements were indexed to body surface area. Patients were divided into 3 age groups: group 1 comprised 9 patients aged 1 to 10 years, group 2 comprised 8 patients aged 11 to 20 years, and group 3 comprised 4 patients aged 21 years or more.

RESULTS: Compared with controls, patients had a significantly wider mitral-aortic separation (group 1, P = .003; group 2, P = .02), a steeper aortoseptal angle (group 1, P = .02; group 3, P = .03), a smaller left ventricular outflow tract width (group 1, P = .003; group 2, P = .01), a marked aortic valve dextroposition (groups 1 and 3), an increased left ventricle wall thickness (group 1, P = .03), and an increased septal thickness (group 1, P = .01). There was a significant difference between preoperative and postoperative values in aortoseptal angle and left ventricular outflow tract width in patients up to 10 years of age (P = .02 and P = .01, respectively).

CONCLUSIONS: Hearts with isolated subaortic stenosis have abnormal left ventricular outflow tract geometry that postoperatively showed changes in left ventricular outflow tract width and aortoseptal angle. Compared with controls, the aortoseptal angle does not "normalize" when surgery is performed in older patients, suggesting that left ventricular outflow tract geometry may be remodeled in younger patients.

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