Clinical experience with the use of a valve-bearing conduit to construct a second left ventricular outflow tract in cases of unresectable intra-ventricular obstruction.
Two patients, ages 7 and 17, with unresectable obstructions within the left ventricular cavity, have been managed by interposing a conduit bearing a porcine aortic valve between the apex of the left ventricle and the infra-renal abdominal aorta. The younger child had idiopathic hypertrophic subaortic stenosis (IHSS) recognized in infancy. At the age of three, a right ventricular myomectomy and a trans-aortic left ventricular myotomy were performed. Symptoms were progressive with congestive failure, diaphoresis, syncope , and angina pectoris. Following construction of a second left ventricular outflow tract with relief of intraventricular obstruction, the patient has become asymptomatic. The second patient has fibrous tunnel obstruction of the left ventricular outflow tracting providing a 100 mm Hg gradient. Fibrous tissue was resected in part through the transaortic route, and a second outflow tract was constructed. A postoperative cardiac catheterization revealed an obliteration of the previous intraventricular gradients and an equal distribution of left ventricular output through the two available outflow tracts. She remains asymptomatic.
D000293:Adolescent; D001020:Aortic Stenosis, Subvalvular / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery*; D002648:Child; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008722:Methods