[HSF] Subaortic stenosis

[Nasser F. Abou'Seada]

I snip the membrane with a scalpel, starting left of the of the RC nadir ...
working anti-clockwise ..cut it with a scissor along the line of attachment
to AML .... dissect it off the aortic annulus with a blunt dissector to
"peel" it off ..... enucleate is the word ..... till it all comes in one
piece ... 

NFA

> From: ICHFNO at aol.com
> We see a fair number of these, and sometimes the fibrous ridge attaches
down
> onto the anterior mitral leaflet  a significant way and can restrict
proper
> closing, resulting in mild to moderate MR. If you have a ridge on echo or
CMR
> and the gradient is 30, then I would say it is a toss up, if however there
> is concomitant MR or any AR it is without question a surgical case.
Regarding
> long term results, the best results are in patients where a septal
myomectomy
> is  performed in addtion to ridge removal, there is a 10-15% recurrence
rate
> when  you do not perform the myomectomy. Be sure you are careful and to
the
> left of  the nadir of the R coronary cusp when you make your incision into
the
> membrane,  to stay away from the conduction tissue. Also, these usually
peel out
> once you  get them started and if you do this the chance for heart block
is
> essentially  nil.
> 
> WNovick