Subvalvar aortic stenosis (subaortic stenosis)
- David W Brown, MD
David W Brown, MD
- Associate Professor of Pediatrics
- Harvard Medical School
Left ventricular outflow tract (LVOT) obstructive lesions account for approximately 6 percent of cases of congenital heart disease in children; in one series, the incidence was estimated to be 6 in 10,000 live births [1,2]. Obstruction may occur at valvar (which is by far the most common), subvalvar, and supravalvar levels.
Subvalvar aortic stenosis (also called subaortic stenosis) will be reviewed here. Valvar and supravalvar aortic stenosis are discussed separately. (See "Valvar aortic stenosis in children" and "Supravalvar aortic stenosis".)
Subvalvar aortic stenosis can be induced by a fixed stenosis, or may have a dynamic component that is primarily due to the genetic disease hypertrophic cardiomyopathy (previously called idiopathic hypertrophic subaortic stenosis). Only fixed stenosis will be reviewed here; subvalvar obstruction due to hypertrophic cardiomyopathy is presented separately. (See "Hypertrophic cardiomyopathy: Morphologic variants and the pathophysiology of left ventricular outflow tract obstruction".)
Subvalvar aortic stenosis (AS) is the second most common form of AS. Among children with congenital AS, subvalvar AS accounts for 10 to 14 percent of cases [2,3]. Similar to valvar AS, subvalvar AS is more common in males, who account for 67 to 75 percent of cases [2,3].
Other cardiac malformations occur in 50 to 65 percent of cases [4-6]. One report of 35 patients found the following lesions: patent ductus arteriosus (34 percent), ventricular septal defect (VSD, 20 percent), aortic coarctation (23 percent), pulmonic stenosis (9 percent), and miscellaneous other lesions (14 percent) .
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- CLINICAL FEATURES
- Physical examination
- Other tests
- - Electrocardiogram
- - Chest radiograph
- - Cardiac catheterization
- Surgical repair
- - Timing
- - Method of correction
- - Outcome
- Endocarditis prophylaxis
- SUMMARY AND RECOMMENDATIONS