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Diffuse subaortic stenosis: modified Konno procedures with aortic valve preservation

P R Vouhé1, R Ouaknine, H Poulain

  • 1Department of Cardiac Surgery, Laënnec Hospital, Paris, France.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 1, 1993
PubMed
Summary

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Modified Konno procedures effectively treat diffuse subaortic stenosis in children, preserving the aortic valve. This surgical approach offers a safe and beneficial alternative for patients without pre-existing aortic valve issues.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Diffuse subaortic stenosis (DSS) often necessitates surgical intervention.
  • The traditional Konno procedure, while effective for DSS, typically requires aortic valve replacement, which may be suboptimal in patients with a normal aortic valve.
  • Alternative surgical strategies are needed to preserve the native aortic valve in select pediatric populations.

Purpose of the Study:

  • To evaluate the efficacy and safety of modified Konno procedures in patients with diffuse subaortic stenosis and a normal aortic orifice.
  • To assess the feasibility of aortic valve preservation during surgical correction of DSS.
  • To compare outcomes between different modified Konno approaches.

Main Methods:

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  • Retrospective analysis of 11 pediatric patients with diffuse subaortic stenosis and normal aortic orifice (tunnel subaortic stenosis or hypertrophic obstructive cardiomyopathy).
  • Procedures included modified Konno techniques: aortoseptal approach with aortic annulus division (5 patients) or conal enlargement without annulus division (6 patients).
  • Outcomes assessed included mortality, reoperation rates, functional status, left ventricular function, and residual gradients.

    • Main Results:

    • One early death (9%) and no late deaths were observed.
    • Two patients required reoperation: one for iatrogenic aortic regurgitation and one for residual ventricular septal defect and mitral regurgitation.
    • Survivors demonstrated good functional class (8/10), normal left ventricular function (9/10), sinus rhythm (10/10), and acceptable left ventricular outflow tract gradients (mean 6 +/- 10 mmHg).

    Conclusions:

    • Modified Konno procedures with aortic valve preservation are a safe and effective treatment for diffuse subaortic stenosis in pediatric patients with normal aortic orifices.
    • These techniques offer a preferable alternative to standard Konno procedures, avoiding unnecessary aortic valve replacement.
    • The study supports the use of modified Konno procedures in infants and children, demonstrating favorable long-term outcomes.