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KMID : 0367219940110010041
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Sejong Medical Journal
1994 Volume.11 No. 1 p.41 ~ p.50
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Operative and Morphologic Study of Congenital Left Ventricular Outflow Tract Obstruction in Congenital Heart Disease
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이영탁
홍민수/심재천/김혁/나찬영/정철현/정윤섭/한재진/박국양
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Abstract
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We had surgical experience of congenital left ventricular outflow tract obstructive lesion as a isolated or combined lesion from Oct. 1986 to Jul. 1992.
The obstructive lesions were identified with echocardiography and/or ventriculography preoperatively, but it might have significant or not significant pressure gradient between left ventricle and ascending aorta.
We classified these 92 cases according to the morphologic lesion, and associated cardiac anomaly, and reviewed the outpatient records for check up the longterm results.
In morphologic classification, septal malalignment was the most frequent(56), and fixed lesion-fibrous/fibromuscular(25), anterolateral muscle hypertrophy(9), tension apparatus (`1) , diffuse tunnel (1).
As an associated anomaly, VSD was most frequent defect - 12 in fixed lesion, 5 in anterolateral muscle hypertrophy, 41 in septal malalignment. All arch anomaly(12 COA, 1 IAA) was associated with the septal malalignment. Other congenital
defects(PDA,
ASD, AVSD) could be associated in any morphologic lesion.
Septal malalignment lesion occurred in 3.4% of all VSD cases in same period (41/1194) and 38.4% in all arch anomaly with VSD (15/39).
The ratio of diameter LVOT/descending aorta in septal malaignment in arch anomaly with VSD was higher than the VSD alone.
Anterolateral muscle hypertrophy could be exist as a isolated lesion(9), but most frequently combined with other morphologic lesion (12 in 25 fixed lesion, 35 in 56 malaignment septal lesion).
Surgical removal was accomplished transaortotomy or through VSD. Excision myectomy and/or membranectomy was routine procedure.
There were 8 early operative mortality ( 2 in VSD 5 in arch anomaly, 1 in C-AVSD), and one late mortality due to congestive heart failure.
Reoperation was done in one case in malaignment type associated fixed lesion 22 months after the first operation.
Definite pressure gradient was exist I 6 cases (4 malaignment type with fixed lesion, 2 fixed lesion). Three permant pacemaker implantation, 1 neurologic sequale were the surgical complications.
Conclusively. The most frequent risk lesion in recurrency was the septal malalignment associated with fixed lesion. And so the lesion sould be excised completely as early as possible.
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