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Left Ventricular Outflow Obstruction in Infancy and Childhood

Left Ventricular Outflow Obstruction in Infancy and Childhood Abstract Left ventricular outflow obstruction occurs in 3% to 5% of cardiac anomalies encountered in the pediatric age group. The obstructing lesion may be supravalvular, valvular, subvalvular, or a combination of more than one lesion.1,2 The indication for surgical intervention in these patients is not yet fully defined. Some controversy exists as to the risk of conservative management as compared to the risk of surgery in patients with moderate obstruction. Most of these children have few symptoms and lead normal lives through childhood and adolescence. With more severe obstructions, it is estimated that the incidence of sudden death may be as high as 7%. Thus, we are confronted with predicting which patient will die suddenly from his aortic stenosis. Also, it may be difficult to decide at what age operations to relieve the valvular stenosis should be performed. It is obvious that the older child is a better surgical risk References 1. Keith, J.D.; Rowe, R.D.; and Vlad, P.: Heart Disease in Infancy and Childhood , New York: The Macmillan Co., Publishers, 1967. 2. Nadas, A.S.: Pediatric Cardiology , Philadelphia: The W. B. Saunders Co., 1963. 3. Swan, H., and Kortz, A.B.: Direct Vision Trans-aortic Approach to the Aortic Valve During Hypothermia: Experimental Observations and Report of Successful Clinical Case , Ann Surg 144:204-214 ( (Aug) ) 1956.Crossref 4. Lewis, F.J., et al: Aortic Valvulotomy Under Direct Vision During Hypothermia , J Thorac Cardiovasc Surg 12:481-499 ( (Oct) ) 1956. 5. Swan, H.C.; Wilkinson, R.H.; and Blount, S.G.: Visual Repair of Congenital Aortic Stenosis During Hypothermia , J Thorac Cardiovasc Surg 35:139-153 ( (Feb) ) 1958. 6. Morrow, A.G., and Brockenbrough, E.C.: Surgical Treatment of Idiopathic Hypertrophic Subaortic Stenosis: Technic and Hemodynamic Results of Subaortic Ventriculomyotomy , Ann Surg 154:181-189 ( (Aug) ) 1961.Crossref 7. Kirklin, J.W., and Ellis, F.H., Jr.: Surgical Relief of Diffuse Subvalvular Aortic Stenosis , Circulation 24:739-750 ( (Oct) ) 1961.Crossref 8. Ellis, F.H., Jr.; Ongley, P.A.; and Kirklin, J.W.: Results of Surgical Treatment of Congenital Aortic Stenosis , Circulation 25:29-38 ( (Jan) ) 1962.Crossref 9. Ellis, F.H., Jr., and Kirklin, J.W.: Congenital Valvular Aortic Stenosis: Anatomic Findings and Surgical Technique , J Thorac Cardiovasc Surg 43:199-202 ( (Feb) ) 1962. 10. Lillehei, C.W., et al: Surgical Treatment of Congenital Aortic Stenosis Using Cardiopulmonary Bypass , Circulation 26:856-872 ( (Nov) ) 1962.Crossref 11. Braunwald, E., et al: Congenital Aortic Stenosis , Circulation 27:426-462 ( (March) ) 1963.Crossref 12. Putnam, T.C., et al: The Surgical Management of Congenital Aortic Stenosis , J Thorac Cardiovasc Surg 48:540-555 ( (Oct) ) 1964. 13. Cooley, D.A., et al: Obstructive Lesions of the Left Ventricular Outflow Tract , Circulation 31:612-621 ( (April) ) 1965.Crossref 14. Peterson, T.A.; Todd, D.B.; and Edwards, J.E.: Supravalvular Aortic Stenosis , J Thorac Cardiovasc Surg 50:734-741 ( (Nov) ) 1965. 15. Thomson, N.B., and Fisher, F.C.: Long-Term Postoperative Follow-up in Surgery for Congenital Aortic Valvular Stenosis , Circulation 32:732-739 ( (Nov) ) 1965.Crossref 16. Landtman, B.; Louhimo, I.; and Wallgren, E.I.: Congenital Aortic Stenosis in Children , Acta Chir Scand 356B:26-34, 1966. 17. Rastelli, G.C., et al: Surgical Treatment of Supravalvular Aortic Stenosis , J Thorac Cardiovasc Surg 51:873-882 ( (June) ) 1966. 18. Mody, M.R.; Nadas, A.S.; and Bernhard, W.F.: Aortic Stenosis in Infants , New Eng J Med 276:832-838 ( (April) ) 1967.Crossref 19. Lillehei, C.W.; Bonnabeau, R.C., Jr.; and Sellers, R.D.: Subaortic Stenosis: Diagnostic Criteria, Surgical Approach, and Late Follow-up in 25 Patients , J Thorac Cardiovasc Surg 55:94-104 ( (Jan) ) 1968. 20. Mulder, D.B., et al: The Surgical Treatment of Congenital Aortic Stenosis , J Thorac Cardiovasc Surg 55:786-795 ( (June) ) 1968. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Left Ventricular Outflow Obstruction in Infancy and Childhood

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Publisher
American Medical Association
Copyright
Copyright © 1969 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1969.01340140129019
Publisher site
See Article on Publisher Site

Abstract

Abstract Left ventricular outflow obstruction occurs in 3% to 5% of cardiac anomalies encountered in the pediatric age group. The obstructing lesion may be supravalvular, valvular, subvalvular, or a combination of more than one lesion.1,2 The indication for surgical intervention in these patients is not yet fully defined. Some controversy exists as to the risk of conservative management as compared to the risk of surgery in patients with moderate obstruction. Most of these children have few symptoms and lead normal lives through childhood and adolescence. With more severe obstructions, it is estimated that the incidence of sudden death may be as high as 7%. Thus, we are confronted with predicting which patient will die suddenly from his aortic stenosis. Also, it may be difficult to decide at what age operations to relieve the valvular stenosis should be performed. It is obvious that the older child is a better surgical risk References 1. Keith, J.D.; Rowe, R.D.; and Vlad, P.: Heart Disease in Infancy and Childhood , New York: The Macmillan Co., Publishers, 1967. 2. Nadas, A.S.: Pediatric Cardiology , Philadelphia: The W. B. Saunders Co., 1963. 3. Swan, H., and Kortz, A.B.: Direct Vision Trans-aortic Approach to the Aortic Valve During Hypothermia: Experimental Observations and Report of Successful Clinical Case , Ann Surg 144:204-214 ( (Aug) ) 1956.Crossref 4. Lewis, F.J., et al: Aortic Valvulotomy Under Direct Vision During Hypothermia , J Thorac Cardiovasc Surg 12:481-499 ( (Oct) ) 1956. 5. Swan, H.C.; Wilkinson, R.H.; and Blount, S.G.: Visual Repair of Congenital Aortic Stenosis During Hypothermia , J Thorac Cardiovasc Surg 35:139-153 ( (Feb) ) 1958. 6. Morrow, A.G., and Brockenbrough, E.C.: Surgical Treatment of Idiopathic Hypertrophic Subaortic Stenosis: Technic and Hemodynamic Results of Subaortic Ventriculomyotomy , Ann Surg 154:181-189 ( (Aug) ) 1961.Crossref 7. Kirklin, J.W., and Ellis, F.H., Jr.: Surgical Relief of Diffuse Subvalvular Aortic Stenosis , Circulation 24:739-750 ( (Oct) ) 1961.Crossref 8. Ellis, F.H., Jr.; Ongley, P.A.; and Kirklin, J.W.: Results of Surgical Treatment of Congenital Aortic Stenosis , Circulation 25:29-38 ( (Jan) ) 1962.Crossref 9. Ellis, F.H., Jr., and Kirklin, J.W.: Congenital Valvular Aortic Stenosis: Anatomic Findings and Surgical Technique , J Thorac Cardiovasc Surg 43:199-202 ( (Feb) ) 1962. 10. Lillehei, C.W., et al: Surgical Treatment of Congenital Aortic Stenosis Using Cardiopulmonary Bypass , Circulation 26:856-872 ( (Nov) ) 1962.Crossref 11. Braunwald, E., et al: Congenital Aortic Stenosis , Circulation 27:426-462 ( (March) ) 1963.Crossref 12. Putnam, T.C., et al: The Surgical Management of Congenital Aortic Stenosis , J Thorac Cardiovasc Surg 48:540-555 ( (Oct) ) 1964. 13. Cooley, D.A., et al: Obstructive Lesions of the Left Ventricular Outflow Tract , Circulation 31:612-621 ( (April) ) 1965.Crossref 14. Peterson, T.A.; Todd, D.B.; and Edwards, J.E.: Supravalvular Aortic Stenosis , J Thorac Cardiovasc Surg 50:734-741 ( (Nov) ) 1965. 15. Thomson, N.B., and Fisher, F.C.: Long-Term Postoperative Follow-up in Surgery for Congenital Aortic Valvular Stenosis , Circulation 32:732-739 ( (Nov) ) 1965.Crossref 16. Landtman, B.; Louhimo, I.; and Wallgren, E.I.: Congenital Aortic Stenosis in Children , Acta Chir Scand 356B:26-34, 1966. 17. Rastelli, G.C., et al: Surgical Treatment of Supravalvular Aortic Stenosis , J Thorac Cardiovasc Surg 51:873-882 ( (June) ) 1966. 18. Mody, M.R.; Nadas, A.S.; and Bernhard, W.F.: Aortic Stenosis in Infants , New Eng J Med 276:832-838 ( (April) ) 1967.Crossref 19. Lillehei, C.W.; Bonnabeau, R.C., Jr.; and Sellers, R.D.: Subaortic Stenosis: Diagnostic Criteria, Surgical Approach, and Late Follow-up in 25 Patients , J Thorac Cardiovasc Surg 55:94-104 ( (Jan) ) 1968. 20. Mulder, D.B., et al: The Surgical Treatment of Congenital Aortic Stenosis , J Thorac Cardiovasc Surg 55:786-795 ( (June) ) 1968.

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1969

References