An unusual complication of a conduit-mounted homograft: valve leaflet fixation in the open position

Surgical management of left ventricular outflow tract obstruction in patients with complete transposition of the great arteries and an intact ventricular septum is difficult. Direct resection of subpulmonary stenosis has not produced satisfactory results. Thus, relief of stenosis has been accomplished with valved conduits from the left ventricle to the pulmonary artery. Initially, conduit tissue valves were porcine in nature. More recently, human-origin conduit tissue valves have been employed. In this report, we describe an unusual complication in a child with complete transposition in whom a homograft valve conduit was placed from the left ventricle to the pulmonary artery to relieve subpulmonary stenosis. The leaflets became fixed in an open position. Thus, the conduit was converted to a functionally nonvalved communication. The subpulmonary stenosis regressed, allowing egress from both the natural outflow tract and the conduit.