Division of Cardiology, Toronto Congenital Cardiac Centre for Adults, University of Toronto, Toronto, Ontario, Canada.
J Am Coll Cardiol. 2011 Aug 23;58(9):962-5. doi: 10.1016/j.jacc.2011.04.029.
The purpose of this study was to determine the prevalence of valvular aortic stenosis requiring surgery in patients with a pre-existing diagnosis of subaortic stenosis.
Classic teachings emphasize aortic regurgitation as the most common complication associated with discrete subaortic stenosis. We hypothesized that significant aortic stenosis may also be an important valve lesion associated with this condition.
Clinical outcomes in patients with subaortic stenosis were examined. The primary outcome of interest was the prevalence of valvular aortic stenosis requiring surgery (surgical valvotomy or valve replacement). Logistic regression was used to identify variables associated with the need for surgery for aortic stenosis.
One hundred twenty-one adults with subaortic stenosis (median age 32 years) were evaluated in our clinic. Associated lesions were common: 23% had bicuspid valves and 21% had coarctation of the aorta. Seventy-nine percent of the patients had at least 1 surgical resection of subaortic tissue (median age 12 years). Moderate to severe aortic regurgitation was present in 16% of patients (19 of 121), 3 of whom required surgical intervention in adulthood. Twenty-six percent of patients (32 of 121) required surgery for valvular aortic stenosis. Valve surgery for aortic stenosis was more common in patients with concomitant bicuspid aortic valve disease (p = 0.008), coarctation of the aorta (p = 0.03), and supravalvular stenosis (p = 0.02).
Valvular aortic stenosis is a surprisingly common finding in patients with discrete subaortic stenosis. Careful clinical follow-up of this population to monitor aortic valve status continues to be warranted even after a successful surgical resection.
本研究旨在确定既往存在主动脉瓣下狭窄（subaortic stenosis）诊断的患者中需要手术治疗的瓣性主动脉瓣狭窄（valvular aortic stenosis）的患病率。
经典理论强调主动脉瓣关闭不全是与离散性主动脉瓣下狭窄相关的最常见并发症。我们假设严重的主动脉瓣狭窄也可能是与这种情况相关的重要瓣膜病变。
研究了主动脉瓣下狭窄患者的临床结局。主要研究结果为需要手术治疗的瓣性主动脉瓣狭窄的患病率（手术切开术或瓣膜置换术）。采用逻辑回归分析确定与主动脉瓣狭窄手术需求相关的变量。
我们的诊所共评估了 121 例主动脉瓣下狭窄的成年人（中位年龄 32 岁）。相关病变很常见：23%的患者存在二叶式主动脉瓣，21%的患者存在主动脉缩窄。79%的患者至少进行了 1 次主动脉瓣下组织的外科切除（中位年龄 12 岁）。16%的患者（121 例中有 19 例）存在中重度主动脉瓣关闭不全，其中 3 例在成年后需要手术干预。26%的患者（121 例中有 32 例）需要进行瓣性主动脉瓣狭窄手术。伴有二叶式主动脉瓣疾病（p=0.008）、主动脉缩窄（p=0.03）和主动脉瓣上狭窄（p=0.02）的患者行主动脉瓣手术治疗主动脉瓣狭窄更为常见。
在离散性主动脉瓣下狭窄患者中，瓣性主动脉瓣狭窄是一种相当常见的发现。即使成功进行了外科切除术，仍需要对该人群进行仔细的临床随访，以监测主动脉瓣状况。
