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Konno procedure for congenital aortic stenosis with a single coronary artery from the left coronary sinus
H Niinami1, Y Imai, K Sawatari
1Department of Pediatric Cardiovascular Surgery, Tokyo Women's Medical College, Japan.
Insights
Congenital aortic stenosis in a child with a unique coronary artery anomaly was successfully treated with the Konno procedure. This surgical approach corrected the aortic stenosis and preserved coronary artery function.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Congenital aortic stenosis poses significant challenges in pediatric patients.
- The Konno aortoventriculoplasty is a complex procedure for severe aortic stenosis.
- An aberrant right coronary artery originating from the left sinus is often considered a contraindication for the Konno procedure due to potential surgical complications.
Observation:
- A 5-year-old girl presented with severe congenital aortic stenosis and an anomalous right coronary artery arising from the left coronary sinus.
- The anomalous coronary artery traversed anteriorly, posing a potential risk during aortic valve and ventricular outflow tract surgery.
Findings:
- The patient underwent successful Konno aortoventriculoplasty with concomitant right coronary artery reimplantation.
- Preoperative pressure gradient across the left ventricle and ascending aorta was 109 mmHg, which was resolved postoperatively.
- Postoperative angiography confirmed the patency of the reimplanted right coronary artery.
Implications:
- This case demonstrates the feasibility of the Konno procedure in select pediatric patients with congenital aortic stenosis and anomalous coronary arteries.
- Surgical modification and coronary artery reimplantation can be a viable option, challenging previous contraindications.
- Successful surgical outcomes highlight the importance of individualized treatment strategies for complex congenital heart defects.
Abstract:
A right coronary artery originating from the left coronary sinus and traversing anteriorly is thought to be one of the contraindications for a Konno aortoventriculoplasty in congenital aortic stenosis because this procedure necessitates incision of the right ventricular outflow tract. The case of a 5-year-old girl with congenital aortic stenosis associated with a single coronary artery, successfully treated surgically by the Konno procedure and right coronary artery reimplantation, is reported. Preoperatively there was a pressure gradient between the left ventricle and the ascending aorta of 109 mmHg, which disappeared postoperatively. A postoperative angiography showed a patent right coronary artery.