Zohair Yousef Al Halees, Saud Al Oufi, Ahmed Al Omrani, Maie Shahid, Mohammed Al Amri, Bahaa Michel Fadel; King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
Objective: Combining the Konno aortoventriculoplasty with a Ross procedure is being utilized increasingly for the management of infants and children with complex left ventricular outflow tract obstruction (LVOTO) associated with aortic valve diseases and/or aortic annular hypoplasia. We have successfully utilized a modification of the aortoventriculoplasty component to relieve the LVOTO without creating a ventricular septal defect (VSD).Methods: Between 1990 and 2004, a total of 435 patients underwent the Ross operation for various aortic valve pathologies at our institution. Thirty-nine of those underwent the modified Ross-Konno procedure. The technique involves an extensive septal myectomy below commissures between the left and the right coronary leaflets without creating a VSD. Furthermore, aortic annular enlargement is used to further augment the LVOT or correct for size mismatch with the usually larger pulmonary autograft.
Results: Age ranged 8 days to 17 years (mean 5.7+ 4.7). Hospital mortality was 5% (2 pts). Follow up ranged 1-12 years, with 20 pts followed up more than two years (mean 4.5± 2 yrs). None of the patients had any residual or recurrent LVOTO or autograft stenosis and only two patients had mild to moderate neo-aortic valve regurgitation. Pulmonary homograft dysfunction was commonly seen (55%) with either stenosis or regurgitation. However, this was well-tolerated in most patients with only two patients requiring re-operation for homograft replacement. The growth of the autograft paralleled somatic growth. In all patients the right and left ventricular function returned to and remained normal.
Conclusion: Our modification of the Ross-Konno technique simplifies this complex procedure and provides an optimal and long lasting relief of LVOTO. In this age group and for this disease, the autograft is durable and has favorable growth potential. The pulmonary homograft has a significant degeneration rate however this is well tolerated and the need for reoperation is low.
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