Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-18T18:53:31.210Z Has data issue: false hasContentIssue false
  • English
  • Français

The Ross, Konno, and Ross–Konno operations for congenital left ventricular outflow tract abnormalities*

Published online by Cambridge University Press:  29 December 2014

Constantine Mavroudis ,
Constantine D. Mavroudis  and
Jeffrey P. Jacobs
Constantine Mavroudis*
Affiliation:
Johns Hopkins Children’s Heart Surgery, Florida Hospital for Children, Orlando, Florida, United States of America
Constantine D. Mavroudis
Affiliation:
Division of Cardiovascular Surgery, University of PennsylvaniaDepartment of Surgery, Philadelphia, Pennsylvania, United States of America
Jeffrey P. Jacobs
Affiliation:
Johns Hopkins Children’s Heart Surgery, All Children’s Hospital, St Petersburg, Florida, United States of America
*
Correspondence to: C. Mavroudis, MD, Johns Hopkins Children’s Heart Surgery, Florida Hospital for Children, 2501N Orange Ave, Suite 540, Orlando, FL 32804, United States of America. Tel: +407 303 3697; Fax: +407 303 3634; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Operations for left ventricular outflow tract abnormalities are centred on hemodynamic conditions that relate to subvalvar stenosis, valvar stenosis/regurgitation, aortic annular hypoplasia, and supravalvar aortic stenosis. Operative interventions over the years have evolved because the intervening outcomes proved to be unsatisfactory. The resection for subvalvar aortic stenosis has progressed from a fibrous “membrane” resection to a more extensive fibromuscular resection. Operative solutions for valvar aortic stenosis and regurgitation have resulted in operative interventions that depend on simple commissurotomy, leaflet extensions, prosthetic mechanical valve replacement, biologic valve replacement, including the pulmonary autograft, and operations to treat aortic annular stenosis. Although there are enthusiastic proponents for all of these strategies, the fact remains that none have proven to be curative; patients can expect to undergo further procedures during their lifetimes. The short- and mid-term solutions to these left ventricular outflow tract abnormalities have improved based on operations that have been attended by increasing operative complexity. The purpose of this review is to chronicle the operative steps of the Ross operation, the Konno–Rastan operation, the modified Konno operation, the Ross–Konno operation, and the modified Ross–Konno operation.

Keywords

CHDleft ventricular outflow tractsubvalvar stenosisvalvar stenosis/regurgitationaortic annular hypoplasiasupravalvar aortic stenosis
Type
Original Article
Information
Cardiology in the Young , Volume 24 , Issue 6: HeartWeek 2014 , December 2014 , pp. 1121 - 1133
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at All Children's Hospital Johns Hopkins Medicine 14th International Symposium on Congenital Heart Disease, Saint Petersburg, Florida, 15–18 February 2014, Special Focus: Diseases of the Cardiac Valves from the Fetus to the Adult, Co-Sponsor: The American Association for Thoracic Surgery (AATS).

References

1.Tchervenkov, CI, Bernier, P-L, Del Duca, D, Hill, S, Ota, N, Mavroudis, C. Left ventricular outflow tract obstruction. In: Mavroudis C, Backer CL, (eds). Pediatric Cardiac Surgery, 4th edn. Wiley Blackwell, Chichester, West Sussex, United Kingdom, 2003; 588--618.Google Scholar
2.Lofland, GK, McCrindle, BW, Williams, WG, et al. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors. Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg 2001; 121: 10–27.CrossRefGoogle ScholarPubMed
3.Rhodes, LA, Colan, SD, Perry, SB, Jonas, RA, Sanders, SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 2325–2335.CrossRefGoogle ScholarPubMed
4.Kovalchin, JP, Brook, MM, Rosenthal, GL, Suda, K, Hoffman, JI, Silverman, NH. Echocardiographic hemodynamic and morphometric predictors of survival after two-ventricle repair in infants with critical aortic stenosis. J Am Coll Cardiol 1998; 32: 237–244.CrossRefGoogle ScholarPubMed
5.Blaufox, AD, Lai, WW, Lopez, L, Nguyen, K, Griepp, RB, Parness, IA. Survival in neonatal biventricular repair of left-sided cardiac obstructive lesions associated with hypoplastic left ventricle. Am J Cardiol 1998; 82: 1138–1140.CrossRefGoogle ScholarPubMed
6.Hickey, EJ, Caldarone, CA, Blackstone, EH, et al. Critical left ventricular outflow tract obstruction: the disproportionate impact of biventricular repair in borderline cases. J Thorac Cardiovasc Surg 2007; 134: 1429–1436; discussion 1436–1437.CrossRefGoogle ScholarPubMed
7.Miyamoto, T, Sinzobahamvya, N, Wetter, J, et al. Twenty years experience of surgical aortic valvotomy for critical aortic stenosis in early infancy. Eur J Cardiothorac Surg 2006; 30: 35–40.CrossRefGoogle ScholarPubMed
8.Calhoon, JH, Bolton, JW. Ross/Konno procedure for critical aortic stenosis in infancy. Ann Thorac Surg 1995; 60 (Suppl 6): S597–S599.CrossRefGoogle ScholarPubMed
9.Reddy, VM, Rajasinghe, HA, Teitel, DF, Haas, GS, Hanley, FL. Aortoventriculoplasty with the pulmonary autograft: the “Ross-Konno” procedure. J Thorac Cardiovasc Surg 1996; 111: 158–165; discussion 165–167.CrossRefGoogle ScholarPubMed
10.Starnes, VA, Luciani, GB, Wells, WJ, Allen, RB, Lewis, AB. Aortic root replacement with the pulmonary autograft in children with complex left heart obstruction. Ann Thorac Surg 1996; 62: 442–448; discussion 448–449.CrossRefGoogle ScholarPubMed
11.Reddy, VM, Rajasinghe, HA, McElhinney, DB, et al. Extending the limits of the Ross procedure. Ann Thorac Surg 1995; 60 (Suppl 6): S600–S603.CrossRefGoogle ScholarPubMed
12.Sudow, G, Solymar, L, Berggren, H, Eriksson, B, Holmgren, D, Gilljam, T. Aortic valve replacement with a pulmonary autograft in infants with critical aortic stenosis. J Thorac Cardiovasc Surg 1996; 112: 433–436.CrossRefGoogle ScholarPubMed
13.van Son, JA, Reddy, VM, Black, MD, Rajasinghe, H, Haas, GS, Hanley, FL. Morphologic determinants favoring surgical aortic valvuloplasty versus pulmonary autograft aortic valve replacement in children. J Thorac Cardiovasc Surg 1996; 111: 1149–1156; discussion 1156–1157.CrossRefGoogle ScholarPubMed
14.Tchervenkov, CI, Bernier, P-L, Del Duca, D, Hill, S, Ota, N, Mavroudis, C. Left ventricular outflow tract obstruction. In: Mavroudis C, Backer CL (eds). Pediatric Cardiac Surgery, 4th edn. Wiley Blackwell, Oxford, UK, 2013.Google Scholar
15.Konno, S, Imai, Y, Iida, Y, Nakajima, M, Tatsuno, K. A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring. J Thorac Cardiovasc Surg 1975; 70: 909–917.CrossRefGoogle ScholarPubMed
16.Cobanoglu, A, Thyagarajan, GK, Dobbs, J. Konno-aortoventriculoplasty with mechanical prosthesis in dealing with small aortic root: a good surgical option. Eur J Cardiothorac Surg 1997; 12: 766–770.CrossRefGoogle ScholarPubMed
17.Ross, DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet 1967; 2: 956–958.CrossRefGoogle ScholarPubMed
18.Stewart, RD, Backer, CL, Hillman, ND, Lundt, C, Mavroudis, C. The Ross operation in children: effects of aortic annuloplasty. Ann Thorac Surg 2007; 84: 1326–1330.CrossRefGoogle ScholarPubMed
19.Brown, JW, Ruzmetov, M, Vijay, P, Bills, RG, Turrentine, MW. Clinical outcomes and indicators of normalization of left ventricular dimensions after Ross procedure in children. Semin Thorac Cardiovasc Surg 2001; 13 (Suppl 1): 28–34.Google ScholarPubMed
20.Cox, DA, Walton, K, Bartz, PJ, Tweddell, JS, Frommelt, PC, Earing, MG. Predicting left ventricular recovery after replacement of a regurgitant aortic valve in pediatric and young adult patients: is it ever too late? Pediatr Cardiol 2013; 34: 694–699.CrossRefGoogle Scholar
21.Woods, RK, Pasquali, SK, Jacobs, ML, et al. Aortic valve replacement in neonates and infants: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2012; 144: 1084–1089.CrossRefGoogle Scholar
22.Tweddell, JS, Earing, MG, Bartz, PJ, Dunham-Ingles, JL, Woods, RK, Mitchell, ME. Valve-sparing aortic root reconstruction in children, teenagers, and young adults. Ann Thorac Surg 2012; 94: 587–590; discussion 590–591.CrossRefGoogle ScholarPubMed
23.Tweddell, JS, Pelech, AN, Jaquiss, RD, et al. Aortic valve repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005: 112–121.CrossRefGoogle ScholarPubMed
24.Slater, M, Shen, I, Welke, K, Komanapalli, C, Ungerleider, R. Modification to the Ross procedure to prevent autograft dilatation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005; 8: 181–184.CrossRefGoogle Scholar
25.Rastan, H, Koncz, J. Aortoventriculoplasty: a new technique for the treatment of left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg 1976; 71: 920–927.CrossRefGoogle ScholarPubMed
26.Mavroudis, C, Backer, CL. Technical tips for three congenital heart operations: modified Ross-Konno procedure, optimal ventricular septal defect exposure by tricuspid valve incision, coronary unroofing and endarterectomy for anomalous aortic origin of the coronary artery. Oper Tech Thorac Cardiovasc Surg 2010; 15: 18–40.CrossRefGoogle Scholar
27.Mavroudis, C, Backer, CL, Kaushal, S. Aortic stenosis and aortic insufficiency in children: impact of valvuloplasty and modified Ross-Konno procedure. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009; 12: 76–86.CrossRefGoogle Scholar
28.Clarke, DR. Extended aortic root replacement for treatment of left ventricular outflow tract obstruction. J Card Surg 1987; 2 (Suppl 1): 121–128.CrossRefGoogle ScholarPubMed
29.Sardari, F, Gundry, SR, Razzouk, AJ, Shirali, GS, Bailey, LL. The use of larger size pulmonary homografts for the Ross operation in children. J Heart Valve Dis 1996; 5: 410–413.Google ScholarPubMed
30.Matte, GS, del Nido, PJ. History and use of del Nido cardioplegia solution at Boston Children’s Hospital. J Extra Corpor Technol 2012; 44: 98–103.CrossRefGoogle ScholarPubMed