Cardiology and Cardiovascular Research

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Results of Aortic Diaphragm Surgery in Senegal: About 20 Cases

Received: 27 March 2018    Accepted: 14 May 2018    Published: 30 May 2018
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Abstract

Introduction: The subaortic diaphragm is a semilunar or circular membrane that is inserted into both the septal wall of the left ventricle and the base or adjacent part of the ventricular surface of the large mitral valve. It represents for 8-20% of all obstacles to left ventricular ejection. Material And Methods: This is a retrospective and descriptive study of patients with aortic stenosis under aortic diaphragmatic surgery operated over an 11-year period (January 2004-December 2015). Our study included 20 patients, 13 of which were male. The sex ratio was 1.85. The average age of patients was 16.6 years [4-51 years]. Stage 2 dyspnea (NYHA) was the primary reason for consultation (17 patients). The heartbeat was regular sinus rhythm in 17 patients. Transthoracic echocardiography (TTE) found left ventricular hypertrophy in 19 patients. The average trans-aortic gradient was 55.68mmHg [24 - 92.5 mmHg]. Aortic insufficiency (IA) was found in 14 patients. An associated congenital heart defect was found in 9 patients. The approach was vertical median sternotomy and transverse aortotomy. The diaphragm was circular in 12 patients and semicircular in 8 patients. The aortic valve was tricuspid in 18 patients and bicuspid in 2 patients. The mean duration of extracorporeal circulation (ECC) was 74.66 minutes [35-119mn] and the mean duration of aortic cross-clamping was 49.11 minutes [20-102mn]. Results: After surgery, disorders of rhythm and conduction were present in 6 patients. At transthoracic ultrasound, left ventricular dysfunction was noted in 3 patients. A tamponade occurred in 1 patient justifying emergency drainage. Two recurrences of subaortic diaphragm were noted, one of which was reoperated after 9 years with a resection of the membrane and a replacement of the aortic valve by a mechanical prosthesis. One death was recorded four days postoperatively. The average postoperative gradient was 21.46mmhg. The average follow-up time was 38 months [5 months - 115 months].

DOI 10.11648/j.ccr.20180202.11
Published in Cardiology and Cardiovascular Research (Volume 2, Issue 2, June 2018)
Page(s) 19-22
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Subaortic Diaphragm, Surgery, Senegal

References
[1] Hassani. B. B. S, Tamdy. A, Rhissassi. J, Amri. R, Arherbi. M Le nouveau concept du diaphragme sous-aortique. Médecine du Maghreb 2010, 179:26-30
[2] Fettouhi. H, Amri. R, Tamdy A, Zarzour. J, Cherti. M. Subaortic stenosis with muscularization of the anterior mitral valve leaflet: two cases. Ann Cardiol Angeiol (Paris). 2010; 59:243-6
[3] Serraf A, Zoghby J, Lacour-Gayet F, Houel R, Belli E et al. Surgical treatment of subaortic stenosis: a seventeen-year experience. J Thorac Cardiovasc Surg. 1999; 117: 669-78
[4] Abid A, Denguir R, Chihaoui M, Khayati A, Abid F. Role of surgery in subaortic stenosis: report of 56 cases. Ann Cardiol Angeiol. 2001; 50:261-8.
[5] Julia S. Donald, Phillip S. Naimo, Yves d’Udekem, Malcolm Richardson, Andrew Bullock, Robert G. Weintraub, Christian P. Brizard, Igor E. Konstantinov. Outcomes of Subaortic Obstruction Resection in Children. Heart, Lung and Circulation (2017) 26, 179–186
[6] Hirata Y, Chen JM, Quaegebeur JM, Mosca RS. The role of enucleation with or without septal myectomy for discrete subaortic stenosis. J Thorac Cardiovasc Surg. 2009; 137:1168-72
[7] Coleman DM, Smallhorn JF, McCrindle BW, Williams WG, Freedom RM. Postoperative follow-up of fibromuscular subaortic stenosis. J Am Coll Cardiol. 1994; 24:1558-64
[8] Brauner R, Laks H, Drinkwater DC Jr, Shvarts O, Eghbali K et al. Benefits of early surgical repair in fixed subaortic stenosis. J Am Coll Cardiol. 1997; 30:1835-42
[9] Marasini M, Zannini L, Ussia GP, Pinto R, Moretti R et al. Discrete subaortic stenosis: incidence, morphology and surgical impact of associated subaortic anomalies. Ann Thorac Surg. 2003;75: 1763-8
[10] Alon Geva, Colin J. McMahon, Kimberlee Gauvreau, Laila Mohammed, Pedro J. del Nido, Tal Geva Risk factors for reoperation after repair of discrete subaortic stenosis in children. JACC Vol. 50, No. 15, 2007:1498–504
[11] Christian Drolet, Joaquim Miro, Jean-Marc Côté, John Finley, Letizia Gardin, Charles V. Rohlicek Longterm pediatric outcome of isolated discrete subaortic stenosis. Canadian Journal of Cardiology 27 (2011) 389.e19–389.e24 www.onlinecjc.ca
[12] Tefera E, Gedlu E, Bezabih A, Moges T, Centella T et al. Outcome in Children Operated for Membranous Subaortic Stenosis: Membrane Resection Plus Aggressive Septal Myectomy Versus Membrane Resection Alone. World J Pediatr Congenit Heart Surg. 2015; 6:424-8
[13] Dodge-Khatami A, Schmid M, Rousson V, Fasnacht M, Doell C et al. Risk factors for reoperation after relief of congenital subaortic stenosis. Eur J Cardiothorac Surg. 2008;33:885-9
[14] Parry AJ, Kovalchin JP, Suda K, McElhinney DB, Wudel J et al. Resection of subaortic stenosis; can a more aggressive approach be justified? Eur J Cardiothorac Surg. 1999; 15:631-8
[15] Jones M, Barnhart GR, Morrow AG. Late results after operations for left ventricular outflow tract obstruction. Am J Cardiol. 1982; 50:569-79
[16] Foker JE. Outcomes and questions about discrete subaortic stenosis. Circulation 2013;127(14):1447–50
Author Information
  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiology, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Intensive Care and Anesthesia, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

  • Department of Cardiovascular and Thoracic Surgery, Cheikh Anta Diop University, Dakar, Senegal

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    Diop Momar Sokhna, Ba Pape Salmane, Diagne Papa Amath, Sow Ndeye Fatou, Thiam Ibou, et al. (2018). Results of Aortic Diaphragm Surgery in Senegal: About 20 Cases. Cardiology and Cardiovascular Research, 2(2), 19-22. https://doi.org/10.11648/j.ccr.20180202.11

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    ACS Style

    Diop Momar Sokhna; Ba Pape Salmane; Diagne Papa Amath; Sow Ndeye Fatou; Thiam Ibou, et al. Results of Aortic Diaphragm Surgery in Senegal: About 20 Cases. Cardiol. Cardiovasc. Res. 2018, 2(2), 19-22. doi: 10.11648/j.ccr.20180202.11

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    AMA Style

    Diop Momar Sokhna, Ba Pape Salmane, Diagne Papa Amath, Sow Ndeye Fatou, Thiam Ibou, et al. Results of Aortic Diaphragm Surgery in Senegal: About 20 Cases. Cardiol Cardiovasc Res. 2018;2(2):19-22. doi: 10.11648/j.ccr.20180202.11

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  • @article{10.11648/j.ccr.20180202.11,
      author = {Diop Momar Sokhna and Ba Pape Salmane and Diagne Papa Amath and Sow Ndeye Fatou and Thiam Ibou and Diatta Souleymane and Gaye Magaye and Leye Mohamed and Sene Etienne Biram and Doumbia Modibo and Dieng Pape Adama and Ciss Amadou Gabriel and Ndiaye Assane and Ndiaye Mouhamadou},
      title = {Results of Aortic Diaphragm Surgery in Senegal: About 20 Cases},
      journal = {Cardiology and Cardiovascular Research},
      volume = {2},
      number = {2},
      pages = {19-22},
      doi = {10.11648/j.ccr.20180202.11},
      url = {https://doi.org/10.11648/j.ccr.20180202.11},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ccr.20180202.11},
      abstract = {Introduction: The subaortic diaphragm is a semilunar or circular membrane that is inserted into both the septal wall of the left ventricle and the base or adjacent part of the ventricular surface of the large mitral valve. It represents for 8-20% of all obstacles to left ventricular ejection. Material And Methods: This is a retrospective and descriptive study of patients with aortic stenosis under aortic diaphragmatic surgery operated over an 11-year period (January 2004-December 2015). Our study included 20 patients, 13 of which were male. The sex ratio was 1.85. The average age of patients was 16.6 years [4-51 years]. Stage 2 dyspnea (NYHA) was the primary reason for consultation (17 patients). The heartbeat was regular sinus rhythm in 17 patients. Transthoracic echocardiography (TTE) found left ventricular hypertrophy in 19 patients. The average trans-aortic gradient was 55.68mmHg [24 - 92.5 mmHg]. Aortic insufficiency (IA) was found in 14 patients. An associated congenital heart defect was found in 9 patients. The approach was vertical median sternotomy and transverse aortotomy. The diaphragm was circular in 12 patients and semicircular in 8 patients. The aortic valve was tricuspid in 18 patients and bicuspid in 2 patients. The mean duration of extracorporeal circulation (ECC) was 74.66 minutes [35-119mn] and the mean duration of aortic cross-clamping was 49.11 minutes [20-102mn]. Results: After surgery, disorders of rhythm and conduction were present in 6 patients. At transthoracic ultrasound, left ventricular dysfunction was noted in 3 patients. A tamponade occurred in 1 patient justifying emergency drainage. Two recurrences of subaortic diaphragm were noted, one of which was reoperated after 9 years with a resection of the membrane and a replacement of the aortic valve by a mechanical prosthesis. One death was recorded four days postoperatively. The average postoperative gradient was 21.46mmhg. The average follow-up time was 38 months [5 months - 115 months].},
     year = {2018}
    }
    

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  • TY  - JOUR
    T1  - Results of Aortic Diaphragm Surgery in Senegal: About 20 Cases
    AU  - Diop Momar Sokhna
    AU  - Ba Pape Salmane
    AU  - Diagne Papa Amath
    AU  - Sow Ndeye Fatou
    AU  - Thiam Ibou
    AU  - Diatta Souleymane
    AU  - Gaye Magaye
    AU  - Leye Mohamed
    AU  - Sene Etienne Biram
    AU  - Doumbia Modibo
    AU  - Dieng Pape Adama
    AU  - Ciss Amadou Gabriel
    AU  - Ndiaye Assane
    AU  - Ndiaye Mouhamadou
    Y1  - 2018/05/30
    PY  - 2018
    N1  - https://doi.org/10.11648/j.ccr.20180202.11
    DO  - 10.11648/j.ccr.20180202.11
    T2  - Cardiology and Cardiovascular Research
    JF  - Cardiology and Cardiovascular Research
    JO  - Cardiology and Cardiovascular Research
    SP  - 19
    EP  - 22
    PB  - Science Publishing Group
    SN  - 2578-8914
    UR  - https://doi.org/10.11648/j.ccr.20180202.11
    AB  - Introduction: The subaortic diaphragm is a semilunar or circular membrane that is inserted into both the septal wall of the left ventricle and the base or adjacent part of the ventricular surface of the large mitral valve. It represents for 8-20% of all obstacles to left ventricular ejection. Material And Methods: This is a retrospective and descriptive study of patients with aortic stenosis under aortic diaphragmatic surgery operated over an 11-year period (January 2004-December 2015). Our study included 20 patients, 13 of which were male. The sex ratio was 1.85. The average age of patients was 16.6 years [4-51 years]. Stage 2 dyspnea (NYHA) was the primary reason for consultation (17 patients). The heartbeat was regular sinus rhythm in 17 patients. Transthoracic echocardiography (TTE) found left ventricular hypertrophy in 19 patients. The average trans-aortic gradient was 55.68mmHg [24 - 92.5 mmHg]. Aortic insufficiency (IA) was found in 14 patients. An associated congenital heart defect was found in 9 patients. The approach was vertical median sternotomy and transverse aortotomy. The diaphragm was circular in 12 patients and semicircular in 8 patients. The aortic valve was tricuspid in 18 patients and bicuspid in 2 patients. The mean duration of extracorporeal circulation (ECC) was 74.66 minutes [35-119mn] and the mean duration of aortic cross-clamping was 49.11 minutes [20-102mn]. Results: After surgery, disorders of rhythm and conduction were present in 6 patients. At transthoracic ultrasound, left ventricular dysfunction was noted in 3 patients. A tamponade occurred in 1 patient justifying emergency drainage. Two recurrences of subaortic diaphragm were noted, one of which was reoperated after 9 years with a resection of the membrane and a replacement of the aortic valve by a mechanical prosthesis. One death was recorded four days postoperatively. The average postoperative gradient was 21.46mmhg. The average follow-up time was 38 months [5 months - 115 months].
    VL  - 2
    IS  - 2
    ER  - 

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