Useful surgical instruments for the resection of subaortic stenosis.

Furthermore, it is difficult for individual cardiovascularsurgeons to gain sufficient experience outside high-volume centers because of the low incidence of surgicalcases. To perform this difficult surgical technique moreeasily,weusemade-to-ordersurgicalinstrumentsforresec-tionofthemembraneormuscleinpatientswithSAS.Thesesurgical instruments are custom-made for the depth andtargetangleinthetransaorticapproach.Wereporttheiruse-fulness in a sample surgical case of SAS.TECHNIQUE AND RESULTSInstrumentsHere we describe the special features of surgical instru-ments for resection of the subaortic region (Figure 1). Thescalpel has a total length of 22 cm and an angle of 140 at3 cm from the tip. It is used by attaching an edge to thetip. The scissors has a total length of 25 cm and an angleof160 rightinthemiddle.Theretractorshaveatotallengthof 30 cm and an angle of 120 at 5 cm from the tip with agroove.CaseAn 11-year-old girl had a diagnosis of discrete SAS withconstrictivepericarditis.Althoughshecouldnotreportsub-jective symptoms because of severe mental disability, weelectedtoperformpericardiotomywithresectionofthesub-aorticmembraneinlightofthehighpeakinstantaneous leftventricular outflow tract (LVOT) gradient of 80 mm Hg.Theoperationwasperformedthroughamediansternotomy.Afterpericardiotomy,thepatientwascooledto32 Cforce-rebral protection under cardiopulmonary bypass andsubsequentcardiacarrest.Afteraortotomy,thesubaorticre-gion was excellently exposed with angled retractors with agroove (Figure 2, A). The obstructive fibrous membrane,which appeared on the LVOT (Figure 2, B), and a part ofthe septal muscle were resected with a scalpel and scissorsangled to enter the septal muscle at a shallow angle(Figure 2, C and D). We confirmed passage of the diameterdilator(15mm).Afterweconfirmedthattherewasnoaorticregurgitation and no injury of the aortic valve, the incisionof the aorta was closed. The postoperative peak instanta-neous LVOT gradient was decreased, and this patient wasdischarged from the hospital on postoperative day 11.DISCUSSIONAlthoughearlysurgicalrepairofSASisassociatedwithasignificant recurrence risk and aortic regurgitation progres-sion,surgicalinterventionisrequiredinpatientswithahighLVOTgradient.