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Valved conduit from the left ventricular apex to ascending aorta for recurrent congenital subaortic stenosis: 25 years later
  1. E Kotschet,
  2. J Federman,
  3. B Davis
  1. ekotschet{at}hotmail.com

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Twenty five years ago, at the age of 9 years, the patient had a membranous subaortic obstruction resected, which recurred three years later, involving all quadrants of the left ventricular outflow tract. As a second transaortic resection was unlikely to be successful, a Hancock porcine valved pulmonary artery conduit was anastomosed from an apical left ventriculotomy to the ascending aorta, shown in the right hand panel with ventriculography taken in the straight 30° right anterior oblique projection. Four years later (age 16 years), severe porcine prosthetic incompetence developed because of cusp rupture and prolapse, a well known complication of conduit valve insertion in children. It was replaced by a pericardial valved pulmonary conduit, sewn end to end within the original conduit shown schematically here. The patient remained asymptomatic for 20 years, including two successful uncomplicated pregnancies. Investigation of recent onset dyspnoea, 25 years since the original conduit surgery, revealed a functionally intact conduit with moderately severe native aortic regurgitation, moderate left ventricular dysfunction, and moderate pulmonary hypertension. A Konno procedure was performed to enlarge the aortic root and allow aortic valve replacement with an ATS mechanical valve. The conduit was removed completely and residual defects closed by primary repair. The postoperative period was complicated by persistent sepsis and refractory elevated pulmonary vascular resistance, with consequent right heart failure. Despite support with a right ventricular assist device, inotropes, and broad spectrum antibiotics, the patient died 12 days postoperatively.


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