Transatrial Exposure for Correction of Subaortic Stenosis

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Abstract
Two patients, 15 and 26 years of age, with unusual forms of subaortic stenosis were studied. One presented an unusually low discrete form and the other, the diffuse muscular hypertrophic form. Preoperatively, the correct anatomic diagnosis was obtained in both by the use of left heart catheterization and angiography. Our past experience with similar lesions was not consistently satisfactory, therefore a new operative approach was applied in both patients. This technique consisted of heart-lung bypass with right posterolateral thoracotomy, left atriotomy, and detachment of the anterior leaflet of the mitral valve along the annulus. In one patient, an associated mitral insufficiency was also corrected by utilizing leaflet advancement. Postoperative left heart catheterization indicated cure in one and significant improvement in the other. Advantages of this method were excellent exposure of the interior of the left ventricle and especially the low ventricular septum, obviation of left ventriculotomy and aortotomy, and continuous coronary perfusion by the natural route.

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