Results of Surgical Treatment of Patients with Diffuse Subvalvular Aortic Stenosis.

The age and sex of the patients and their presenting symptoms are shown in table 1. Two of the patients, cases 3 and 6, had a family history suggesting that the disease was familial. A murmur had been present before the age of 5 years in case 6, while the remainder of the patients had become aware of the presence of a heart murmur after age 12. Symptoms were moderate to severe in all patients except one, case 13, who had only mild symptoms. On physical examination there was a sharp upstroke to the arterial pulse on palpation. There was usually a left ventricular lift and a systolic ejection murmur along the lower left sternal border with poor radiation to the base of the heart and neck. Three of the patients had a holosystolic murmur at the apex consistent with mitral insufficiency. The intensity of the murmurs ranged from grade II to IV (on the basis of I to VI). Roentgenographic and fluoroscopic study of the chest revealed left ventricular enlargement in 12 cases and left atrial enlargement in six. None of the patients was noted to have calcification of the aortic valve. Preoperative electrocardiograms revealed a sinus rhythm and left ventricular hypertrophy with ST-segment depression and abnormal T waves in all cases. One patient exhibited first-degree heart block. Three patients had a left axis deviation, and one patient showed a pre-excitation pattern of the Wolff-Parkinson-White type. Hemodynamic studies in our institution included percutaneous puncture of the left ventricle