Taylor N C, Somerville J
Br Heart J. 1981 Jun;45(6):689-97. doi: 10.1136/hrt.45.6.689.
Three patients who had closure of an ostium primum defect developed severe fixed subaortic stenosis requiring surgical removal three to 11 years late. In two, the basic anatomy of the attachment of the superior portion of the anterior mitral cusp and submitral apparatus predisposed to the formation or deterioration of this complication. Both had subvalvar gradients and angiographic narrowing of the outflow tract in systole and diastole. In the third patient the strut of the Hancock prosthesis used to replace a double orifice mitral valve impinged on the outflow tract to stimulate the formation of a serious fixed obstruction. Subaortic gradients before operation must be specifically looked for, particularly in those with the characteristic radiological deformity of the submitral apparatus, and at operation the subaortic region must be inspected. Postoperatively the search for developing subaortic stenosis must include regular M-mode and 2-dimensional echocardiography, and cardiac catheterisation may be required. Although a rare complication, subaortic stenosis is a progressive and damaging lesion which requires early recognition and treatment despite the apparent well-being of the patient.
三名原发孔缺损闭合的患者在3至11年后出现严重的固定性主动脉瓣下狭窄，需要手术切除。其中两名患者，二尖瓣前叶上部和二尖瓣下装置附着的基本解剖结构易导致该并发症的形成或恶化。两人均有瓣下梯度，收缩期和舒张期流出道造影显示狭窄。第三名患者，用于替换双孔二尖瓣的汉考克人工瓣膜支柱压迫流出道，促使形成严重的固定性梗阻。术前必须特别检查主动脉瓣下梯度，尤其是那些具有二尖瓣下装置特征性放射学畸形的患者，手术时必须检查主动脉瓣下区域。术后寻找进展性主动脉瓣下狭窄必须包括定期的M型和二维超声心动图检查，可能还需要进行心导管检查。尽管主动脉瓣下狭窄是一种罕见的并发症，但它是一种进行性且有损害的病变，尽管患者表面状况良好，仍需要早期识别和治疗。
