Radical aortic root enlargement in the infant and child

Complex multilevel left ventricular outflow tract obstruction includes some of the more challenging problems in congenital cardiac reconstructive surgery. Preoperative studies must carefully delineate the level of obstruction that may be entirely below the aortic annulus (i.e., subaortic stenosis), at the level of the aortic annulus (i.e., aortic annular hypoplasia), may be related to valve leaflet obstruction due to rigid or fused valve leaflets (i.e., aortic valve stenosis), or may be at the level of the tips of the commissures of the aortic valve (i.e., supravalvar aortic stenosis). Frequently, variable contributions are present from all these potential levels of obstruction. An important underlying goal in planning surgical therapy should be preservation of the child's own aortic valve, whenever possible. Operative procedures should preserve growth potential and minimize the need for repeat surgical procedures. A number of surgical options that incorporate these goals will be described.