Aortoventriculoplasty ad modum Konno. Experience with five cases

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Defects

Background:

• Congenital valvular aortic stenosis often presents with extreme annular narrowing in pediatric patients.
• Effective surgical management is crucial for improving outcomes and long-term prognosis.

Purpose of the Study:

• To evaluate the safety and efficacy of Konno's aortoventriculoplasty in children with congenital valvular aortic stenosis and hypoplastic aortic annulus.
• To assess the potential for significant aortic annulus enlargement and appropriate prosthesis implantation.

Main Methods:

• Konno's aortoventriculoplasty was performed in 5 pediatric patients with severe aortic stenosis and annular hypoplasia.
• Surgical outcomes, including bleeding complications and prosthesis size, were meticulously documented.
• Long-term follow-up was conducted to assess the durability of the surgical repair.

Main Results:

• One hospital death occurred, unrelated to the surgical procedure itself.
• The 4 surviving patients experienced manageable bleeding from stitch holes post-bypass, irrespective of patch material.
• Significant enlargement of the aortic annulus was achieved, allowing implantation of adult-sized prostheses (≥21 mm).

Conclusions:

• Konno's aortoventriculoplasty is a safe and effective procedure for widening hypoplastic aortic annuli in children.
• The technique successfully relieves ventricular outflow tract obstruction and allows for anatomically positioned prosthetic valve implantation.
• This approach obviates the need for a left ventricular apical-aortic conduit, simplifying surgical management.