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Transthoracic echocardiography does not reliably predict involvement of the aortic valve in patients with a discrete subaortic shelf

Published online by Cambridge University Press:  26 April 2010

Justin H. Booth ,
Roosevelt Bryant III ,
Susan C. Powers ,
Shuping Ge ,
E. Dean McKenzie ,
Jeffrey S. Heinle ,
Charles D. Fraser Jr  and
David L. S. Morales
Justin H. Booth
Affiliation:
The University of Texas Medical School, Houston, United States of America Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, United States of America
Roosevelt Bryant III
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, United States of America The Michael E. Debakey Department of Surgery, Baylor College of Medicine, Texas, United States of America
Susan C. Powers
Affiliation:
The Department of Pediatrics, Baylor College of Medicine, Texas, United States of America
Shuping Ge
Affiliation:
The Department of Pediatrics, Baylor College of Medicine, Texas, United States of America
E. Dean McKenzie
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, United States of America The Michael E. Debakey Department of Surgery, Baylor College of Medicine, Texas, United States of America
Jeffrey S. Heinle
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, United States of America The Michael E. Debakey Department of Surgery, Baylor College of Medicine, Texas, United States of America
Charles D. Fraser Jr
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, United States of America The Michael E. Debakey Department of Surgery, Baylor College of Medicine, Texas, United States of America
David L. S. Morales*
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, United States of America The Michael E. Debakey Department of Surgery, Baylor College of Medicine, Texas, United States of America
*
Correspondence to: D L. S. Morales, MD, Texas Children’s Hospital, 6621 Fannin, Houston, Texas, USA. Tel: 832-826-1915; Fax: 1(832) 825-1905; E-mail: dlmorale@texaschildrens.org
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Abstract

Background

A discrete subaortic membrane cannot only cause left ventricular outflow tract obstruction, but can grow onto the aortic valve leaflets. The late finding of this encroachment is aortic valve insufficiency or stenosis. Echocardiography is used to follow the progression of outflow tract obstruction, but its ability to show subaortic membrane encroachment onto the aortic valve is unclear. The purpose of this study is to determine the sensitivity and specificity of echocardiography for diagnosing whether a discrete subaortic membrane involves the aortic valve.

Methods

A pre-operative determination of aortic valve involvement by a discrete subaortic membrane was obtained by review of the official pre-operative echocardiogram reading and a retrospective blinded review of the pre-operative echocardiogram by an independent echocardiographer. These findings were compared to the intra-operative findings.

Results

A total of 48 consecutive patients underwent primary resection for isolated discrete subaortic membrane between October, 1995 and May, 2006. The pre-operative and blinded readings both predicted a statistically lower rate of aortic valve involvement – 35% in 11 of 31 patients and 31% in 10 of 31 patients, respectively – than found at surgery – 65% in 31 of 48 patients. The sensitivity and specificity of pre-operative echocardiography to diagnose aortic valve involvement is 35% and 76%. Overall survival was 100%. There were no strokes, re-operations for bleeding or wound infections, or need for a pacemaker.

Conclusion

Echocardiography is not sensitive in assessing whether a discrete subaortic membrane involves the aortic valve. Since the morbidity and mortality for discrete subaortic membrane resection is negligible, resection may be indicated at the time of diagnosis to minimise aortic valve impairment.

Keywords

Subaortic stenosisleft ventricular outflow tractcongenital cardiac surgeryechocardiographydiscrete subaortic membrane
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 3 , June 2010 , pp. 284 - 289
Copyright
Copyright © Cambridge University Press 2010

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