Recurrent subaortic membrane removal with homograft explant

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Cardiac Reconstruction

Background:

• Recurrent subaortic membranes can cause significant left ventricular outflow tract (LVOT) obstruction, necessitating complex surgical intervention.
• Previous interventions, including homograft aortic root implantation, may complicate reoperations.
• Patient's challenging social circumstances precluded alternative surgical options like the Ross-Konno procedure or mechanical valves.

Purpose of the Study:

• To describe the surgical management of a recurrent subaortic membrane with severe LVOT obstruction.
• To detail the aortic root enlargement and reconstruction techniques used in a reoperation setting.
• To highlight the rationale for prosthesis selection in a patient with complex social factors.

Main Methods:

• Reoperation via re-sternotomy and cardiopulmonary bypass for recurrent subaortic membrane resection.
• Enlargement of the aortic root from 12 mm to 21 mm, involving resection of the native annulus and previous homograft.
• Reconstruction of the LVOT using pericardium and implantation of a 21 mm Konect valved conduit prosthesis.

Main Results:

• Successful resection of the subaortic membrane and septal myectomy.
• Aortic root enlargement and successful implantation of the Konect prosthesis.
• Reconstruction with pericardium and Gore-Tex membrane for potential future access.

Conclusions:

• Complex reoperations for subaortic membranes are feasible with careful surgical planning and execution.
• Aortic root enlargement and reconstruction with a valved conduit can effectively relieve LVOT obstruction.
• Prosthesis selection must consider anatomical factors, patient characteristics, and psychosocial considerations.