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Ann Thorac Surg 1998;65:1368-1376
© 1998 The Society of Thoracic Surgeons
a Department of Thoracic-Cardiovascular Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
b Department of Pediatrics, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
Address reprint requests to Dr Roughneen, Department of Thoracic-Cardiovascular Surgery, Loyola University Medical Center, 2160 South First Ave, Maywood, IL 60153
Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.
Background. Diffuse or unresectable subaortic stenosis (SAS) necessitates an aggressive surgical approach for the elimination of left ventricular outflow tract obstruction. In this article we report our experience with the modified Konno-Rastan procedure, with inherent preservation of the native aortic valve and annulus, in the treatment of diffuse or unresectable SAS.
Methods. Sixteen children (age range, 21 months to 18 years) underwent the modified Konno-Rastan procedure through either a transventricular (n = 12) or a transatrial approach (n = 4) to the conal septum. Indications for operation were recurrent SAS (n = 3), hypertrophic obstructive cardiomyopathy (n = 3), tunnel stenosis (n = 2), SAS related to a canal (n = 3), and SAS after ventricular septal defect closure (n = 5). Eleven patients had undergone previous procedures and 5 underwent the modified Konno-Rastan procedure as their primary operation.
Results. The mean preoperative left ventricular outflow tract gradient of 50 ± 17 mm Hg was reduced to 3 ± 7 mm Hg (p < 0.001) after surgical repair. Postoperative complications included sternal infection (n = 1), heart block (n = 2), mediastinal bleeding (n = 1), and renal and cerebral ischemia (n = 1). There was 1 late postoperative death caused by pneumonia 2 years after operation (6.2% mortality rate). The mean follow-up period was 62 ± 39 months and all patients had complete relief of preoperative symptoms and were in New York Heart Association class I. One patient underwent a successful redo modified Konno-Rastan procedure 7 years after the first operation for residual left ventricular outflow tract obstruction immediately below the aortic valve. One patient is awaiting reoperation for aortic incompetence unrelated to conal enlargement 1.5 years after the first procedure.
Conclusions. The modified Konno-Rastan procedure represents an excellent therapy for diffuse or unresectable SAS in patients with a normal aortic valve. In addition, it produces excellent results in a limited number of patients with hypertrophic obstructive cardiomyopathy, in whom the Morrow procedure traditionally has been performed. Although it usually is performed through a transventricular approach, the modified Konno-Rastan procedure also can be performed through a transatrial approach; this is particularly useful in patients who have had previous ventricular septal defect closure associated with SAS occurring proximal to the prosthetic patch.
This article has been cited by other articles:
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  C. A. Caldarone, T. L. Van Natta, J. R. Frazer, and D. M. Behrendt The modified Konno procedure for complex left ventricular outflow tract obstruction Ann. Thorac. Surg., January 1, 2003; 75(1): 147 - 151. [Abstract] [Full Text] [PDF]
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P. T. Roughneen Invited commentary Ann. Thorac. Surg., January 1, 2003; 75(1): 151 - 152. [Full Text] [PDF]
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A. T. Gurbuz, W. M. Novick, C. A. Pierce, and D. C. Watson Left ventricular outflow tract obstruction after partial atrioventricular septal defect repair Ann. Thorac. Surg., November 1, 1999; 68(5): 1723 - 1726. [Abstract] [Full Text] [PDF]
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