右腋下小切口部分型心内膜垫缺损修补术——6例报告

目的　报道经右侧腋下小切口 ,修补部分型心内膜垫缺损的手术方法及结果。　方法　1997年 11月至 2 0 0 0年 1月 ,6例部分型心内膜垫缺损患者经右侧腋下小切口 ,完成了二尖瓣成形 (心脏跳动下观察二尖瓣返流情况及成形效果 )加Ⅰ孔房缺修补术。其中 1例解剖性单心房 ,1例过渡型心内膜垫缺损。 6例均有二尖瓣前叶裂 ,其中 3例合并二尖瓣中度关闭不全 ,1例重度关闭不全 ,1例三尖瓣中度关闭不全。　结果　切开长度 (8 3± 1 3)cm ,循环阻断时间 (32 8± 8 3)分钟 ,体外循环时间 (6 6 0± 9 0 )分钟。 1例术后二尖瓣仍有少 -中量返流 ,其余患者二尖瓣关闭良好 ,无房水平残余分流。 6例均顺利康复出院。术后随访 (1 1± 0 7)年 ,患者心功能良好 ,无死亡及并发症。　结论　经右侧腋下小切口行部分型心内膜垫缺损修补术 ,是一种安全、微创的手术方法。其中心脏跳动下观察二尖瓣返流情况 ,可为瓣膜成形提供可靠依据。     

冠状窦顶重建治疗无顶综合征合并心内膜垫缺损和永存左上腔静脉

目的 总结冠状静脉窦顶重建在无顶冠状静脉窦综合征合并心内膜垫缺损和永存左上腔静脉的外科治疗经验.方法 2000年1月至2008年1月共753例心内膜垫缺损病人行畸形矫治手术,15例(2%)同时合并永存左上腔静脉和无顶冠状静脉窦综合征,包括部分型心内膜垫缺损12例,完全型心内膜垫缺损3例.均在行心内膜垫缺损矫治术同期重建冠状静脉窦顶,1例直接结扎左上腔静脉,14例将左上腔静脉隔入右房,其中10例用自体心包补片,4例通过折叠左房后壁完成冠状静脉窦顶的重建,最后在重建的冠状静脉窦开口的左侧缝合修补房间隔缺损.结果 术后早期1例死于严重肺部感染.术后随访3个月～6年,无远期死亡病例.14例术后均未见腔静脉、肺静脉回流梗阻和心房水平残余分流.1例行左房后壁折叠分隔左上腔静脉者术后早期超声心动图提示左上腔静脉入左房顶处血流速度偏快.结论 合并心内膜垫缺损和永存左上腔静脉的无顶冠状静脉窦综合征外科治疗有难度,冠状窦顶重建技术能够取得良好的治疗效果.     

双孔三尖瓣畸形的诊断与治疗

目的分析双孔三尖瓣畸形的诊断与治疗特点,总结治疗经验。方法回顾性分析中南大学湘雅二医院2008年8~12月收治的3例双孔三尖瓣畸形患者的病例资料,其中男1例,女2例;年龄20~67岁。1例术前临床诊断为法洛四联症,行法洛四联症矫治术,缝闭三尖瓣副孔;1例术前临床诊断为部分型心内膜垫缺损合并三尖瓣关闭不全,行心内膜垫缺损矫治术,未处理三尖瓣副孔;1例术前临床诊断为风湿性心脏病、二尖瓣重度狭窄、二尖瓣闭式扩张术后、主动脉瓣狭窄合并关闭不全、三尖瓣关闭不全、心房颤动,行二尖瓣置换、主动脉瓣置换、三尖瓣成形术,缝闭三尖瓣副孔。结果 3例患者手术时间170~192 min,体外循环时间120~143 min,主动脉阻断时间77~95 min;术后3~5 d复查彩色超声心动图提示：结果均正常,术后7~8 d均康复出院;出院后分别于1个月、3个月、6个月及1年行常规检查,恢复良好;彩色超声心动图提示：无三尖瓣反流,三尖瓣副孔处无异常血流。结论双孔三尖瓣畸形副孔有独立的瓣叶、腱索和乳头肌,能启闭自如。尸检是其主要诊断手段,其次为手术和彩色超声心动图检查。仅三尖瓣副孔伴有瓣膜关闭不全或狭窄的患者有血流动力学异常时才需手术处理。     

冠心病合并室壁瘤及二尖瓣关闭不全的外科治疗

目的 总结冠心病合并室壁瘤和二尖瓣关闭不全的外科治疗经验及效果. 方法 回顾性分析78例冠心病合并室壁瘤和二尖瓣关闭不全患者的临床资料,其中男45例,女33例;年龄42～70岁,平均年龄55岁.室壁瘤位于心尖部44例,外侧壁14例,下壁20例; 二尖瓣中度关闭不全48例,重度关闭不全30例.手术在低温体外循环下施行,室壁瘤线性缝合术24例,心内膜环缩、三明治缝合术36例,心内膜环缩、左心室补片成形术18例,同期血栓清除术13例;二尖瓣成形术42例,二尖瓣置换术36例;移植旁路血管1～6支(2.5±1.5支). 结果 围术期死亡5例,死于败血症1例,多器官功能衰竭2例,心力衰竭2例.术中停机困难5例.术后主要并发症:低心排血量综合征、恶性心律失常和多器官功能衰竭.左心室舒张期末内径(55.6±1.2 mm vs. 68.2±4.0 mm),射血分数(45%±23% vs.34%±14%),心功能分级(NYHA,1.82±0.26级 vs. 3.36±0.56级)与术前比较差异均有统计学意义(P<0.05).随访69例,随访率94.52%,随访时间25±8个月.随访期间无远期死亡,无症状复发.心功能Ⅰ～Ⅱ级58例,Ⅲ级9例,Ⅳ级2例, 较术前明显改善(P<0.05). 结论 根据病理生理特点选择对心腔、血管和瓣膜全面处理的手术方式,加强围术期管理,手术治疗冠心病合并室壁瘤及二尖瓣关闭不全的近、远期疗效满意.     

先天性心脏病术中心脏瓣膜的保护和矫治

目的 总结先天性心脏病术后因瓣膜功能不全再手术的经验。方法 回顾分析先天性心脏病术后再行瓣膜手术13例患者的临床资料,其中室间隔缺损修补术后8例,部分心内膜垫缺损修补术后3例,法洛四联症和房间隔缺损修补术后各1例。第1次手术时即存在二尖瓣轻～中度关闭不全6例,主动脉瓣关闭不全1例;新出现瓣膜功能异常6例,其中2例因补片漏致三尖瓣关闭不全,2例因前叶腱索断裂致三尖瓣关闭不全,1例因残留右心室流出道狭窄继发三尖瓣关闭不全,1例因伤及主动脉瓣并发二尖瓣和三尖瓣关闭不全。13例中,行二尖瓣置换6例,三尖瓣置换2例,主动脉瓣置换1例,行主动脉瓣置换并二尖瓣、三尖瓣成形1例,三尖瓣成形3例。同时修补残余漏,疏通右心室流出道。结果 术后发生低心排综合征3例。2例术后早期分别死于脑气栓和呼吸循环衰竭。11例术后痊愈出院,随访1～8年,心功能良好。结论 先天性心脏病矫治术中应注意心脏瓣膜的保护,合并的瓣膜功能异常应积极修补,及时地再手术可取得良好效果。     

部分心内膜垫缺损合并双孔二尖瓣的外科治疗（附5例报告）

部分心内膜垫缺损合并双孔二尖瓣的外科治疗（附５例报告）刘迎龙，李守军，萧明第，朱晓东双孔二尖瓣是罕见的心脏畸形，常与其他心脏畸形并存，以部分心内膜垫缺损（ＰＥＣＤ）最常见。术前易漏诊，往往术中发现。现就我们诊治的５例报告如下：临床资料１９７９年至１９...     

二尖瓣成形术112例

目的总结先天性心脏病合并二尖瓣关闭不全患者的二尖瓣成形手术方法和临床效果. 方法 112例先天性心脏病患者主要病种为房室间隔缺损29例、室间隔缺损25例、动脉导管未闭14例、房间隔缺损14例等,合并二尖瓣关闭不全的主要病理改变为瓣环扩大58例、瓣叶裂隙37例、前、后瓣叶脱垂36例等.二尖瓣成形方法为瓣叶裂隙缝合34例,Cosgrove环环缩瓣环22例,交界环缩18例,双孔法14例等.术中左心室注水观察、评价成形后二尖瓣反流程度,脱离体外循环后食管超声心动图观察成形结果. 结果全组无死亡,1例因人工腱索断裂行二尖瓣置换术,术后门诊随访二尖瓣反流0 ～Ⅰ级72例,Ⅱ级26例.术前左心室舒张期末直径大于或等于45 mm 62例,术后随访左心房、左心室缩小,与术前比较差别有显著性意义(t=6.53,7.89,P<0.001). 结论先天性心脏病合并二尖瓣关闭不全病理改变较多,根据不同病理改变采取相应的二尖瓣成形方法,甚至需要同时采用多种措施才能获得满意效果;术中行食管超声心动图能为判断手术效果提供有益的帮助.     

缺血性二尖瓣关闭不全的外科治疗

目的总结缺血性二尖瓣关闭不全的外科治疗经验.方法 12例缺血性二尖瓣关闭不全患者,其中二尖瓣大量反流9例,中量反流3例,均有心肌梗死史,术前心功能Ⅱ级4例,Ⅲ级4例,Ⅳ级4例,均接受冠状动脉旁路移植术和同期保留二尖瓣和瓣下结构的二尖瓣置换术.结果 1例术后并发肺部感染死亡,其余患者均痊愈出院,出院时心功能为Ⅰ～Ⅱ级.随访3～59个月,无远期死亡,亦无抗凝和机械瓣膜引起的并发症,患者心功能仍为Ⅰ～Ⅱ级.术后早期超声心动图检查示左心室舒张期末内径和左心房舒张期末内径均较术前缩小(P<0.05).结论缺血性心脏病伴缺血性中至重度二尖瓣反流行冠状动脉旁路移植术加二尖瓣置换术疗效可靠.     

完全电视胸腔镜下心脏手术108例

自2000年程云阁等在国内开展首例完全电视胸腔镜下房间隔缺损修补术以来,电视胸腔镜技术逐渐应用到心脏外科领域[1].从2010年1月至2011年11月,我们在电视胸腔镜下完成心脏手术108例,效果良好,现报道如下. 资料和方法 本组中男50例,女58例;年龄10～61岁,平均29岁;平均体重49.5 kg.根据患者临床表现、心电图、X线心脏平片、心脏超声心动图检查等明确诊断.房间隔缺损65例,伴轻度肺动脉高压34例,合并三尖瓣轻度关闭不全30例;室间隔缺损27例,膜周部室间隔缺损18例,嵴内型7例,干下型2例;二尖瓣关闭不全7例,其中后叶脱垂5例,前叶脱垂2例;风湿性二尖瓣狭窄或关闭不全6例,均为单瓣膜病变;部分型心内膜垫缺损3例.     

缺血性二尖瓣关闭不全的外科治疗

目的　探讨缺血性二尖瓣关闭不全的外科治疗方法 ,分析影响手术疗效的因素。方法　1998年 4月至 2 0 0 3年 11月 ,外科治疗 4 4例冠心病缺血性二尖瓣关闭不全 ,其中轻～中度 7例 ,中度 2 4例 ,重度 13例。行二尖瓣成形术 30例 ,其中交界区瓣环成形术 12例 ,用人工瓣环行瓣环成形术 17例 ,1例行双孔二尖瓣成形 ;4例同时行后瓣叶楔形切除 ,1例作腱索转移。瓣膜置换术 14例 ,置入双叶机械瓣 12例 ,生物瓣 2例。结果　全组手术死亡 7例 ,其中低心排出量综合征或心衰死亡 4例 ,心律失常 2例 ,脑栓塞 1例。 33例术后平均随访 2 0个月 ,远期死亡 2例 ,生存者远期心功能I～II级 2 9例 ,III级 2例。术后超声复查左心室内径较术前明显缩小 [(6 2 3± 6 3)mm对 (5 4 3± 7 1)mm]。行瓣膜成形术者远期复查超声显示无反流或轻微反流 12例 ,轻度反流 5例 ,中度反流 2例。瓣膜置换术者 12例出现瓣周漏 ,其余病例瓣膜功能良好。统计分析显示 ,左心室功能、临床心功能级别与手术风险相关。结论　冠心病合并二尖瓣关闭不全应积极处理 ,手术矫治方式应根据瓣膜病理改变及心功能决定 ,尽量施行瓣膜成形术。     

Surgical repair of double-orifice of the mitral valve in cases with an atrioventricular canal defects

OBJECTIVE: A Double-orifice in the mitral valve is an uncommon congenital cardiac lesion which occurs as an isolated anomaly or in association with other cardiac malformation. This report deals with our surgical experience of a double-orifice of the mitral valve in cases with an atrioventricular canal defect. PATIENTS AND METHODS: From 1991 through 1999, ten patients were diagnosed to have a double-orifice of the mitral valve at Shizuoka Children's Hospital. Each patient had associated major cardiac malformations, among which atrioventricular canal defect underwent surgical management, with five of these undergoing complete correction with or without previous pulmonary artery banding. Of these 10, the five cases were enrolled in this study. Two of these had a complete type, and the other three had a partial type. The cleft in the left-sided atrioventricular valve was closed partially in four and left untouched in one. Bridging tissue, when present, was left intact. There was no regurgitation from any accessory orifice and no repair for an accessory orifice was needed. RESULT: There was no late death and no replacement of the valve with prosthesis. During follow-up ranging from 1 to 4 years, none of the patients developed severe stenosis or progressive regurgitation in the left-sided atrioventricular valve. CONCLUSION: Meticulous surgical management of a double-orifice in the mitral valve in association with atrioventricular canal defect an achieve an acceptable midterm result without developing severe dysfunction in the left-sided atrioventricular valve.     

Unusual mitral valve abnormalities complicating surgical repair of endocardial cushion defects

A review of 155 cases of surgically repaired endocardial cushion defects revealed 16 patients (10%) with additional unusual mitral valve abnormalities that complicated the surgical procedure. Eight patients had accessory mitral valve tissue that connected the anterior and posterior leaflets to form a double-orifice valve (Group I). In four (50%), the lesion was associated with intermediate atrioventricular canal and small left ventricle; all four died following repair. In the other four, it was associated with ostium primum defect; all survived and are well. A single papillary muscle in the left ventricle was present in six patients (Group II). Two had intermediate atrioventricular canal and both died postoperatively. The other four had complete endocardial cushion defect and three are well following the operation. Perforation of the valve leaflets was present in two patients with ostium primum (Group III). Both patients are well postoperatively. Modification of the surgical technique is required to effect satisfactory repair. The bridge connecting the posterior and anterior leaflets of the mitral valve should be left undisturbed. Otherwise, severe regurgitation may result. In patients with single papillary muscle and complete atrioventricular canal, repair may be accomplished by borrowing from the tricuspid portion of the anterior leaflet, rotating that part posteriorly, and partially closing the cleft. Small perforations of the mitral leaflet do not require closure and do not result in regurgitation. Echocardiographic and angiographic delineation of these abnormalities and thorough intraoperative exploration are important in avoiding pitfalls at the time of repair.     

Surgical treatment of double-orifice mitral valve in atrioventricular canal defects. Experience in 25 patients

Double-orifice mitral valve is an uncommon but surgically important condition. The experience in 25 cases of double-orifice mitral valve associated with atrioventricular canal defects was reviewed. This constituted 4.3% of the 581 cases of atrioventricular canal defects operated upon between 1961 and July, 1984. The combined mitral orifice area ranged from 85% to 91% of normal in those patients whose valves were sized intraoperatively. Ten associated cardiac defects were repaired in six patients. Of 23 patients having cleft mitral valve, 21 had partial closure of the cleft. There was one operative death (4.0%), which occurred early in the series in a patient in whom the tissue bridge was severed and massive mitral regurgitation resulted. In the remaining 24 patients the tissue bridge was left intact, and all survived operation. No patient had clinically significant mitral stenosis during a follow-up of 1 to 14 years (mean 4.9 years). Two patients (8%) developed progressive mitral regurgitation and required mitral valve replacement 3 and 11 years postoperatively. One of these patients died and a second death occurred suddenly 2 years following operation. All survivors are in Functional Class I or II. The noncleft orifice of a double-orifice mitral valve usually is competent and rarely requires closure. The cleft, because it constitutes a type of parachute (single papillary muscle) valve, should be closed partially so as to relieve valve incompetence without causing undue stenosis. The incidence of late development of mitral regurgitation is similar to that of atrioventricular canal without double-orifice mitral valve. Repair of atrioventricular canal associated with double-orifice mitral valve can be achieved with a low operative mortality and excellent late results.     

Successful surgical correction for an incomplete endocardial cushion defect in an elderly patient

A 72-year-old female who presented with symptoms of severe congestive heart failure, was subsequently diagnosed as having an incomplete endocardial cushion defect. A severe left-to-right shunt and mitral and tricuspid valve regurgitation were noted. Closure of the ostium primum defect, mitral valve replacement, and tricuspid valve annuloplasty were performed simultaneously. The postoperative course was uneventful. A review of literature revealed that this is the oldest such surgical patient described in Japan to date. We believe that surgical correction can be effective even in elderly patients.     

二尖瓣成形术的临床研究(附131例报告)

目的 总结二尖瓣成形手术方法 和临床效果.方法 对131例各种病因引起的二尖瓣关闭不全实施成形手术,术中发现二尖瓣的病理改变有瓣环扩大、瓣叶脱垂、瓣叶裂、瓣叶增厚、钙化、赘生物形成和腱索断裂、三瓣化等.成形的方法有:瓣环环缩、交界缝缩、补片扩大前叶、双孔成形、后叶矩形切除、钙化灶及赘生物切除、人工瓣环植入等.术中采用注水试验和经食管超声检查成形效果.结果 手术死亡2例,二次开胸止血3例,急性肾功能衰竭2例.术后1周、3个月及9个月心脏彩超检查:左房内径、左室舒张末径缩小,左室射血分数提高.术后9个月心脏彩超检查:无或轻度返流98例,中度返流29例,重度返流2例(1例于10个月后行二尖瓣置换术).结论 术中根据瓣膜不同的病理改变特点,灵活采用多种成形方法 ,可以取得较好的成形效果,术中经食管超声或注水试验效果不佳者,应考虑瓣膜置换.     

Complete endocardial cushion defect: the late result of repair using the single-patch technique

Twenty-two patients have been followed for between 1 and 105 months after repair of a complete endocardial cushion defect. The mean period of follow-up is 3.5 years. The single-patch technique was used in every patient. The mitral valve was repaired with buttressed sutures in those seen more recently. The mean age at the time of operation was 15 months. Early in this experience, 4 patients had severe mitral valve incompetence after an initially satisfactory repair. In none of those patients had the mitral valve been repaired with pledgeted sutures. Two of those patients survived reoperation, and 2 died before a second operation could be performed. Every mitral valve is now repaired with pledgeted sutures, and there have been no failures of the mitral valve reconstruction. Each patient has been followed by the same pediatric cardiologist every 6 to 12 months after operation. The vast majority (17 of 20) are asymptomatic. Twelve have no mitral valve incompetence, and the remainder have only trivial or mild incompetence. Clinically, the pulmonary artery hypertension has resolved in 19 of 20 patients. Each patient remains in normal sinus rhythm. The long-term results following repair of complete endocardial cushion defect with the single-patch technique are excellent, but pledgeted sutures should be used in the mitral valve repair to insure its integrity.     

A surgical repair of complete endocardial cushion defect associated with single atrium, persistent left superior vena cava draining into the left atrium, hemiazygos connection and double orifice mitral valve]

Successful surgical repair of a 1-year-old girl of complete endocardial cushion defect associated with single atrium, persistent left superior vena cava draining into the left atrium, hemiazygos connection and double orifice mitral valve was reported. We repaired the endocardial cushion defect by using an endocardial cushion prosthesis and a new atrial septum was created to allow the left superior vena cava draining into the right atrium. We made no treatment for the accessory mitral valve orifice because of no regurgitation.     

完全性心内膜垫缺损合并右室双出口的双心室修复

目的 总结完全性心内膜垫缺损合并右室双出口双心室修复的经验.方法 2006年7月至209年11月对6例完全性心内膜垫缺损合并右室双出口病人采用双片法修补完全性心内膜垫缺损,人工血管补片作右心室内隧道,连接室间隔缺损与主动脉口,引导左心室血经内隧道进入主动脉;应用牛心包补片扩大右室流出道;肺动脉瓣环小者用带瓣补片跨环修补右室流出道;心室内隧道有可能阻塞右室流出道造成重度梗阻者,右室流出道与主肺动脉之间安置带瓣管道(Rastelli手术).结果 术后死亡1例,占16.6%,其余病例恢复良好.结论 完全性心内膜垫缺损合并右室双出口一期双心室修复可获得良好效果.

Abstract：

Objective Double-outlet right ventricle,which often associated with total anomalous pulmonary venous connection and complete endocardial cushion defects,has been considered a risk factor for biventricular repair procedure.To reviewed cases treated by biventricular repair for endocardial cushion defects with double outlet right ventricle.Methods From July to November of 2009,6 patients (3 males and 3 females) aged from 7 to 24 (16.17±5.98) years and with endocardial cushion defects and double outlet right ventricle underwent operation of biventricular repair The duration of follow-up ranged from 10 days to 2 years(median,16 months).Endocardial cushion defects were repaired with a 2-patch technique.The artificial vascular patch was implanted to connect the ventricular septal defects and the aorta for draining the blood stream from the left ventricle to the aorta.The other patch was used to repair the ostium primum atrial septal defects.Right ventricular outflow tract obstructions was released and reconstructed by transplanting a bovine pericardium patch.If the size of pulmonary valve annulus was far more below the normal,a transannular pericardial patch was used.Rastelli procedure with a valved conduit between the right ventricle and the pulmonary artery would be performed if the obstruction in the right ventricular outfolw tract was severe.Results One death occurred 2 days after the operation,resulting in a mortality rate of 16.6%.The case,a boy of 7 years old,had a mirror-image dextrocardia,complete endocardial cushion defect ( C type),anomalous pulmonary venous drainage and single atrium.In this case,the operation lasted for 8 hours,acute renal failure happened next day to the operation,the effect of CRRT was unsatisfied,and eventually cardiac arrest occurred as a result of hyperkalemia.The remaining cases had survived.Follow-up examinations showed that the systolic pressure gradients across the pulmonary valves decreased,with a range of 14 to 40 mm Hg,(23.9 ± 11.03) mm Hg.Mild mitral and tricuspid regurgiration were identified in 4 cases and moderate mitral regurgitation was identified in one case.The cardiac function in all patients was classified as NYHA class Ⅰ/Ⅱ,Conclusion Endocardial cushion defects with double outlet right ventricle can be corrected by means of biventricular repair procedure.The procedure was associated with a low mortality,The interim life quality of patients may be improved.The longterm outcomes should be further studied.     

Operative results of atrioventricular canal defect

Partial Atrioventricular Canal Defect ( PAVC ) The operative results of this anomaly is generally acceptable. Between 1978 and 1982, 32 patients with PAVC underwent intracardiac repair. Two operative deaths occurred in 41 and 42 years old patients who were in NYHA class 4 preoperatively. Postoperative mitral insufficiency was either nil or mild except in one patient with mitral valve prolapse which was left unrepaired. Complete Atrioventricular Canal Defect ( CAVC ) Our operative procedures for the repair of CAVC are as follows, 1) all of accessory chordae are cut off and the bridging leaflet is incised into mitral and tricuspid components. 2) Ventricular septum, atrioventricular valve and atrial septum are constructed with our designed endocardial cushion prosthesis (Dacron prosthesis with pericardial brim of 3-4 mm width in each side). Between 1978 and 1982, 20 patients with CAVC containing 16 infants less than 2 years old underwent intracardiac repair using this prosthesis. Thirteen patients had no severe associated anomalies and only one death occurred in this group. Three patients were combined with tetralogy of Fallot (one died) and two patients with double outlet right ventricle (one died). The other two patients had either coarctation of the aorta (died) or interruption of the aortic arch (survived).     

Surgical options in subaortic stenosis associated with endocardial cushion defects

Over a 15-year period, 12 patients with endocardial cushion defects undergoing correction had subaortic stenosis requiring operative intervention. Ages ranged from 4 months to 17 years (mean, 7 +/- 6 years) and subaortic gradients from 15 to 100 mm Hg (mean, 60 +/- 25 mm Hg). Subaortic stenosis was due to discrete fibromuscular tissues in 7 patients, mitral valve malattachment in 3, and tunnel outflow in 2. In 2, the subaortic stenosis was clinically significant at the time of endocardial cushion defects repair, whereas in 10 it was noted 2 to 14 years postoperatively (mean, 6.3 +/- 5 years). Surgical relief of subaortic stenosis was accomplished by resection of muscle tissues in 7, apicoaortic conduit insertion in 2, modified Konno procedure (aortic valve preserved) in 2, and lifting of malattached mitral valve from the outflow in 1. There was no early death and one late death (infected conduit). Severe mitral insufficiency developed in the patient who had the mitral valve lifted and necessitated valve replacement. Postoperative echocardiographic gradient in 9 patients ranged from 0 to 36 mm Hg (mean, 10.5 +/- 14 mm Hg). Clinically significant subaortic stenosis has not developed in any patient in 15 years of follow-up (mean, 5 +/- 4 years). We conclude that in subaortic stenosis associated with endocardial cushion defects, resection is effective for discrete obstruction, whereas a modified Konno procedure is preferable for obstruction due to tunnel outflow or mitral valve malattachment.