Left ventricular outflow enlargement by the Konno procedure

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Thoracic Surgery

Background:

• Optimal management for small aortic annulus or left ventricular outflow tract (LVOT) obstruction is not well-defined.
• Many patients require reoperations due to complex congenital heart disease.

Purpose of the Study:

• To evaluate the efficacy and outcomes of the Konno procedure or its modification for left ventricular outflow tract enlargement.
• To assess the feasibility of implanting a sufficiently sized aortic valve in patients with small aortic annuli.

Main Methods:

• Eighteen patients underwent left ventricular outflow tract enlargement using the Konno procedure with Dacron and pericardial patches.
• A Dacron patch was used to enlarge the LVOT after septal incision, allowing for at least a 21 mm valve implantation.
• The ascending aorta was also enlarged, and a pericardial patch closed defects in the right ventricular outflow tract.

Main Results:

• The pressure gradient across the LVOT was eliminated in all 18 patients during surgery.
• One early death occurred due to heterograft valve degeneration in a patient with a prior left ventricular apical-aortic conduit.
• One late death was attributed to bacterial endocarditis in a patient with complex comorbidities. Sixteen patients are functioning well, with 13 on aspirin and 3 on warfarin.

Conclusions:

• The Konno procedure is an acceptable and effective method for treating small aortic annuli and LVOT obstructions.
• This surgical approach offers advantages over left ventricular apical-aortic conduits for selected patients.
• The procedure facilitates the implantation of appropriately sized valves, improving outcomes in complex pediatric and adult cardiac cases.