Hipertrofia septal assimétrica: técnica de correção e análise da evolução pós-operatória

The dynamic subaortic stenosis, more commonly named hypertrofic subaortic stenosis (HSS) presents some aspects specially related with its diagnosis and surgical treatment. From September/83 to September/89, sixteen patients (10 men) with age between 7 month and 66 years (30.87 ± 2.42) were submitted to surgical treatment to correct the HSS. The surgical technique employed the muscular resection in left ventricular outflow tract, in the anterior wall, between left and right coronary aortic sinus. This resection was characterized by an extensive and deeply miectomy and was performed with no other procedures in 10 patients and in association with other procedures in 6 patients (correction of patent arterious ductus with fibrotic subaortic stenosis in 2; surgical conservative procedure in aortic valve stenosis in one; right ventricle muscular anomalous band resection of vegetative lesion in aortic leaflet in one; interventricular septum communication closure and aortic valve conservative procedure in one. After cardiopulmonary by-pass, intraoperative evaluation in aortic and left ventricle pressure were made in all patients. No immediate deaths were present in this group of patients. There was one (6.2%) death with one year of follow-up, not related with the disease. After surgery related to AV disturbances, one (6.2%) patient presented AV block with need of pacemaker implantation; two (12.5%) presented left bundle block; three (18.7%) presented left bundle branch block, with no alteration in the other patients. In the late follow-up, between 19 and 90 months (56.00 ± 23.72), 14 (87.5%) patients are with no symptoms.