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The modified Konno procedure for complex left ventricular outflow tract obstruction.

Christopher A Caldarone1, Timothy L Van Natta, Jeffrey R Frazer

  • 1Division of Cardiothoracic Surgery, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. chris-caldarone@uiowa.edu

The Annals of Thoracic Surgery
|January 23, 2003
PubMed
Summary

The modified Konno procedure effectively treats complex left ventricular outflow tract (LVOT) obstruction, preserving aortic valve function. This surgical approach shows promise for reducing obstruction and preventing recurrence in high-risk patients.

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Complex left ventricular outflow tract (LVOT) obstruction requires aggressive subaortic resection while preserving aortic valve function.
  • The modified Konno procedure offers extensive LVOT exposure but raises concerns regarding aortic valve injury, conduction system damage, and residual ventricular septal defects (VSD).

Purpose of the Study:

  • To evaluate the safety and efficacy of the modified Konno procedure for complex LVOT obstruction.
  • To assess the impact of the modified Konno procedure on aortic valve function and the incidence of residual VSD.

Main Methods:

  • Retrospective analysis of 18 patients who underwent the modified Konno procedure between 1994 and 2001.
  • Data reviewed included patient demographics, LVOT obstruction type, preoperative and postoperative echocardiographic gradients, aortic insufficiency, conduction abnormalities, and VSD presence.

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Main Results:

  • The modified Konno procedure significantly reduced LVOT peak gradients (70.4 to 19.2 mm Hg, p < 0.001).
  • No perioperative deaths occurred; aortic insufficiency remained mild or less in most patients.
  • No permanent heart block was observed, though 28% had small residual VSDs.

Conclusions:

  • The modified Konno procedure is an effective treatment for complex LVOT obstruction, successfully preserving aortic valve function.
  • Consideration of this procedure for initial management in high-risk cases may prevent recurrent LVOT obstruction.