Management of complex left ventricular outflow tract obstruction with pulmonary autografts.
The surgical relief of complex multilevel left ventricular outflow tract (LVOT) obstruction remains a challenging surgical problem. We present a new operation which combines the concepts of aortoventriculoplasty, extended aortic root replacement, and the use of a pulmonary autograft. Sixteen patients underwent this operation: 11 patients after previous attempts to relieve diffuse subvavalvular stenosis and 5 patients who presented excessive gradients over a previous aortic valve prosthesis. All patients except one survived the operation. One patient developed massive right ventricular infarction and underwent transplantation after 5 days. Another patient developed complete heart block and transient tricuspid regurgiation after a septal infarction. One patient remained in congestive heart failure and died suddenly after 17 months. All other patients are in NYHA class I after a mean follow-up of 23 +/- 12 months. One patient developed progressive dilatation of the neo-aortic root and underwent reoperation after 4 years. All other patients showed laminar flow in the LVOT and excellent function of the autograft and homograft valve at follow-up. This operation offers a more durable or even a definitive solution in the management of these complex left ventricular outflow tract obstructions.
Department of Cardiac Surgery, Gasthuisberg University Hospital, Leuven, Belgium.
W J
WJ
Daenen
D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D011183:Postoperative Complications; D011664:Pulmonary Valve / Q000637:transplantation*; D014182:Transplantation, Autologous; D014656:Vascular Surgical Procedures / Q000379:methods; D014694:Ventricular Outflow Obstruction / Q000601:surgery*