SURGICAL TREATMENT OF LEFT VENTRICULAR OUTFLOW OBSTRUCTION

The group of defects that create increased load on the left ventricle includes stenosis of the left ventricle (LV), valvular and supravalvular aortic stenosis, coarctation of the aorta. Such defects require surgical treatment.Objective is to evaluate the results of surgical treatment of patients with combined obstruction of outflow ways from LV and to optimize the tactics of treatment.Material and methods. From 2012 to 2018 we operated 9 children with multilevel stenosis of the outflow pathways of the leftventricle in age from 3 days to 2.5 years old. In 4 cases coarctation of the aorta with subaortic stenosis was diagnosed, in 4 cases - coarctation of the aorta with valvular aortic stenosis, in one child - valvular and supravalvular aortic stenosis. Patients underwent stage-by-stage correction of defects according to their hemodynamic significance.Results. In 8 cases, the primary elimination of the leading hemodynamically significant stenosis led to a decrease in pressure gradient at this level. In patients who underwent removal of distal narrowing without proximal correction, pressure gradient at the proximal level significantly increased from 28.8 to 35 mm Hg. There was one fatal outcome in the newborn after resection of aortic coarctation with plasty of aortic arch and closure of ventricular septal defect.Summary. 1. Assessment of hemodynamic significance of stenosis at the proximal level with multilevel obstruction of the ways of outflow from LV cannot be made by simple summation of pressure gradient at the proximal and distal levels. 2. We consider pressure gradient at the proximal level of the stenosis ≥30 mm Hg to be hemodynamically significant and requireing simultaneous correction. 3. The use of intraoperative EchoCG may be useful to assess the severity of the proximal obstruction. 4. Surgical intervention for coarctation of the aorta should be performed from the median sternotomy access in case of doubtful hemodynamic insignificance of proximal stenosis.

обструкция, субаортальный стеноз, аортальный стеноз, надклапанный стеноз, коарктация аорты, градиент давления, obstruction, subaortic stenosis, aortic stenosis, supravalvular stenosis, coarctation of the aorta, pressure gradient