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Konno procedure using atrioventricular groove patch plasty after arterial switch operation.
Yoshimichi Kosaka1, Hiromi Kurosawa, Masayoshi Nagatsu
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
The Annals of Thoracic Surgery
|October 30, 2004
Summary
A novel surgical technique successfully enlarged a small aortic annulus in a patient with transposition of the great arteries, addressing neoaortic regurgitation and stenosis after arterial switch. This modified Konno procedure preserved vital coronary anatomy for a positive outcome.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Transposition of the great arteries (TGA) requires complex surgical correction, often involving arterial switch operations.
- Long-term complications include neoaortic valve insufficiency and stenosis, necessitating reintervention.
- Shaher type 9 coronary anatomy presents unique challenges in TGA repair.
Observation:
- A patient with TGA and Shaher type 9 coronary anatomy developed progressive neoaortic valvular regurgitation and stenosis 15 years post-arterial switch.
- The small neoaortic annulus and supravalvular stenosis prevented standard prosthetic valve implantation.
- The patient also had neopulmonary supravalvular stenosis.
Findings:
- A modified Konno procedure was performed to enlarge the neoaortic annulus anteriorly.
- Atrioventricular groove patch plasty was utilized, successfully avoiding compromise of the right coronary artery.
- This innovative approach allowed for the implantation of a clinically adequate prosthetic valve.
Implications:
- This technique offers a viable solution for aortic annular hypoplasia in complex TGA cases with challenging coronary anatomy.
- It expands the surgical options for reoperative TGA management, improving patient outcomes.
- Preservation of coronary arteries during complex annular enlargement is crucial for long-term success.