Repair of complex left ventricular outflow tract obstruction in children
Rune Eggum1, Kjell Saatvedt, Egil Seem
1Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, University of Oslo, Oslo, Norway. rune.eggum@rikshospitalet.no
Insights
Surgical repair for complex left ventricular outflow tract obstruction (LVOTO) in children, including Ross-Konno procedures, shows acceptable early and late mortality. Survivors demonstrate good physical performance and quality of life.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Complex left ventricular outflow tract obstruction (LVOTO) in children often requires advanced surgical interventions.
- Procedures like the Ross-Konno and Koncz-Konno are established treatments for pediatric LVOTO.
- This study reviews outcomes from a decade of surgical management for complex LVOTO.
Purpose of the Study:
- To evaluate the results of surgical interventions for complex left ventricular outflow tract obstruction (LVOTO) in pediatric patients over a 10-year period.
- To assess the efficacy and safety of various surgical techniques, including the Ross-Konno and Koncz-Konno procedures.
- To determine the early and late mortality rates and the long-term quality of life for patients undergoing these complex cardiac surgeries.
Main Methods:
- A retrospective analysis of 17 pediatric patients with complex LVOTO operated on between December 1991 and April 2002.
- Exclusion of patients treated with less complex procedures like balloon valvuloplasty or simple valve replacement.
- Detailed reporting of surgical procedures performed (Koncz-Konno, Ross-Konno, Ross) and concomitant interventions, patient demographics, and follow-up data.
Main Results:
- Three early deaths occurred among the 17 patients, with mortality distributed across different surgical groups.
- One late death occurred 8 years postoperatively due to unknown causes.
- The majority of surviving patients exhibited normal physical performance and a good quality of life post-surgery.
Conclusions:
- Biventricular repair is a viable surgical option for selected pediatric patients with complex LVOTO.
- The early and late mortality associated with these complex cardiac surgeries is deemed acceptable.
- Surgical management of complex LVOTO in children can lead to favorable long-term functional outcomes and improved quality of life.
Background:
Complex obstruction of the left ventricular outflow tract (LVOTO) in children may be treated with surgical procedures like the Ross-Konno or Koncz-Konno procedures, or modifications thereof. We present our results from the last 10 years.
Material And Method:
During the period from December 1991 to April 2002, 17 patients/children with complex LVOTO were operated on. Patients treated with balloon valvuloplasty, open commisurotomy or simple valve replacement are excluded. The procedures performed were: Koncz-Konno (KK) or modified KK (n = 10), Ross-Konno (RK) (n = 2) and Ross (RO) (n = 5). Concomitant procedures included mitral valve replacement (n = 1), aortic arc plasty (n = 1), subvalvular myotomi (n = 1), resection of subvalvular membrane (n = 1) and aorto-coronary bypass (n = 1). Patients' ages ranged from 1 to 178 months, median 71 months. Body weights ranged from 3.8 to 50.0 kg, median 19.4 kg. Eight cases were redo procedures.
Results:
Three early deaths occurred. One patient in the KK group, one in the modified KK group and one in the RK group. One patient died 8 years postoperatively of unknown reasons; no autopsy was performed. The rest of our patients who survived the initial major surgical treatment show normal physical performance and their quality of life seems to be good.
Conclusion:
Patients with complex LVOTO can be operated with biventricular repair in selected cases. Early and late mortality are acceptable.
