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J Thorac Cardiovasc Surg 2003;125:423-425
© 2003 The American Association for Thoracic Surgery

Brief Communications

Mitral annular and left ventricular outflow tract enlargement with autologous tissue: Extended application of the Ross-Konno procedure

José M. Caffarena, MD, PhDa,b, Miguel Rovirosa, MDb, Jose M. Gòmez-Ullate, MDa Barcelona, Spain

From the Pediatric Cardiac Surgery Department, Children's Hospital La Fe,a Valencia, and Children's Hospital Sant Joan de Deu,b Barcelona, Spain.

Received for publication July 12, 2002. Accepted for publication July 18, 2002. Address for reprints: José M. Caffarena, MD, PhD, Pediatric Cardiac Surgery Department, Hospital Infantil La Fe, C/ Avda de Campanar s/n, 46009 Valencia, Spain (E-mail: josecaffarena@telefonica.net).

The first 20% of the full text of this article appears below.

Tunnel-type subaortic stenosis with aortic valve involvement combined with mitral stenosis and annular hypoplasia, frequently seen with Shone anomaly or related conditions, may have a severe presentation in infancy, with aortic valvulotomy and mitral valve replacement being necessary at an early age.Go 1 These patients subsequently may have severe gradients across the mitral prosthesis because of body growth, along with frequent complex aortic obstructions that are aggravated by the protrusion of the mitral prosthesis into the left ventricular outflow tract.

Faced with the seeming inevitability of performing a double mitral-aortic valve replacement, we developed an alternative technique that enlarges the mitral annulus, allowing the accommodation of a prosthesis of a greater size and at the same time resolving the complex aortic obstruction. The objective is to minimize the use of prosthetic material and to use autologous tissue in these growing children.

Method

We use deep hypothermic cardiopulmonary bypass. After aortic crossclamping, blood cardioplegic solution is administered through the aortic root. The retrograde route is used for dose maintenance. The aorta is sectioned along the commissural plane, and the aortic valve is resected, with extraction of coronary arteries and a generous circumference . . . [Full Text of this Article]






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