Modified Konno-Rastan procedure for subaortic stenosis: Indications, operative techniques, and results

Patrick Roughneen, Serafin Y. DeLeon, Frank Cetta, Dolores A. Vitullo, Timothy J. Bell, Elizabeth A. Fisher, Bradford P. Blakeman, Mamdouh Bakhos

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background. Diffuse or unresectable subaortic stenosis (SAS) necessitates an aggressive surgical approach for the elimination of left ventricular outflow tract obstruction. In this article we report our experience with the modified Konno-Rastan procedure, with inherent preservation of the native aortic valve and annulus, in the treatment of diffuse or unresectable SAS. Methods. Sixteen children (age range, 21 months to 18 years) underwent the modified Konno-Rastan procedure through either a transventricular (n = 12) or a transatrial approach (n = 4) to the conal septum. Indications for operation were recurrent SAS (n = 3), hypertrophic obstructive cardiomyopathy (n = 3), tunnel stenosis (n = 2), SAS related to a canal (n = 3), and SAS after ventricular septal defect closure (n = 5). Eleven patients had undergone previous procedures and 5 underwent the modified Konno-Rastan procedure as their primary operation. Results. The mean preoperative left ventricular outflow tract gradient of 50 ± 17 mm Hg was reduced to 3 ± 7 mm Hg (p <0.001) after surgical repair. Postoperative complications included sternal infection (n = 1), heart block (n = 2), mediastinal bleeding (n = 1), and renal and cerebral ischemia (n = 1). There was 1 late postoperative death caused by pneumonia 2 years after operation (6.2% mortality rate). The mean follow-up period was 62 ± 39 months and all patients had complete relief of preoperative symptoms and were in New York Heart Association class I. One patient underwent a successful redo modified Konno-Rastan procedure 7 years after the first operation for residual left ventricular outflow tract obstruction immediately below the aortic valve. One patient is awaiting reoperation for aortic incompetence unrelated to conal enlargement 1.5 years after the first procedure. Conclusions. The modified Konno-Rastan procedure represents an excellent therapy for diffuse or unresectable SAS in patients with a normal aortic valve. In addition, it produces excellent results in a limited number of patients with hypertrophic obstructive cardiomyopathy, in whom the Morrow procedure traditionally has been performed. Although it usually is performed through a transventricular approach, the modified Konno-Rastan procedure also can be performed through a transatrial approach; this is particularly useful in patients who have had previous ventricular septal defect closure associated with SAS occurring proximal to the prosthetic patch.

Original languageEnglish (US)
Pages (from-to)1368-1376
Number of pages9
JournalAnnals of Thoracic Surgery
Volume65
Issue number5
DOIs
StatePublished - May 1998
Externally publishedYes

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Pathologic Constriction
Aortic Valve
Ventricular Outflow Obstruction
Ventricular Heart Septal Defects
Hypertrophic Cardiomyopathy
Heart Block
Aortic Valve Insufficiency
Brain Ischemia
Reoperation
Pneumonia
Hemorrhage
Kidney
Mortality
Therapeutics
Infection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Modified Konno-Rastan procedure for subaortic stenosis : Indications, operative techniques, and results. / Roughneen, Patrick; DeLeon, Serafin Y.; Cetta, Frank; Vitullo, Dolores A.; Bell, Timothy J.; Fisher, Elizabeth A.; Blakeman, Bradford P.; Bakhos, Mamdouh.

In: Annals of Thoracic Surgery, Vol. 65, No. 5, 05.1998, p. 1368-1376.

Research output: Contribution to journalArticle

Roughneen, P, DeLeon, SY, Cetta, F, Vitullo, DA, Bell, TJ, Fisher, EA, Blakeman, BP & Bakhos, M 1998, 'Modified Konno-Rastan procedure for subaortic stenosis: Indications, operative techniques, and results', Annals of Thoracic Surgery, vol. 65, no. 5, pp. 1368-1376. https://doi.org/10.1016/S0003-4975(97)01421-5
Roughneen, Patrick ; DeLeon, Serafin Y. ; Cetta, Frank ; Vitullo, Dolores A. ; Bell, Timothy J. ; Fisher, Elizabeth A. ; Blakeman, Bradford P. ; Bakhos, Mamdouh. / Modified Konno-Rastan procedure for subaortic stenosis : Indications, operative techniques, and results. In: Annals of Thoracic Surgery. 1998 ; Vol. 65, No. 5. pp. 1368-1376.
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abstract = "Background. Diffuse or unresectable subaortic stenosis (SAS) necessitates an aggressive surgical approach for the elimination of left ventricular outflow tract obstruction. In this article we report our experience with the modified Konno-Rastan procedure, with inherent preservation of the native aortic valve and annulus, in the treatment of diffuse or unresectable SAS. Methods. Sixteen children (age range, 21 months to 18 years) underwent the modified Konno-Rastan procedure through either a transventricular (n = 12) or a transatrial approach (n = 4) to the conal septum. Indications for operation were recurrent SAS (n = 3), hypertrophic obstructive cardiomyopathy (n = 3), tunnel stenosis (n = 2), SAS related to a canal (n = 3), and SAS after ventricular septal defect closure (n = 5). Eleven patients had undergone previous procedures and 5 underwent the modified Konno-Rastan procedure as their primary operation. Results. The mean preoperative left ventricular outflow tract gradient of 50 ± 17 mm Hg was reduced to 3 ± 7 mm Hg (p <0.001) after surgical repair. Postoperative complications included sternal infection (n = 1), heart block (n = 2), mediastinal bleeding (n = 1), and renal and cerebral ischemia (n = 1). There was 1 late postoperative death caused by pneumonia 2 years after operation (6.2{\%} mortality rate). The mean follow-up period was 62 ± 39 months and all patients had complete relief of preoperative symptoms and were in New York Heart Association class I. One patient underwent a successful redo modified Konno-Rastan procedure 7 years after the first operation for residual left ventricular outflow tract obstruction immediately below the aortic valve. One patient is awaiting reoperation for aortic incompetence unrelated to conal enlargement 1.5 years after the first procedure. Conclusions. The modified Konno-Rastan procedure represents an excellent therapy for diffuse or unresectable SAS in patients with a normal aortic valve. In addition, it produces excellent results in a limited number of patients with hypertrophic obstructive cardiomyopathy, in whom the Morrow procedure traditionally has been performed. Although it usually is performed through a transventricular approach, the modified Konno-Rastan procedure also can be performed through a transatrial approach; this is particularly useful in patients who have had previous ventricular septal defect closure associated with SAS occurring proximal to the prosthetic patch.",
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T2 - Indications, operative techniques, and results

AU - Roughneen, Patrick

AU - DeLeon, Serafin Y.

AU - Cetta, Frank

AU - Vitullo, Dolores A.

AU - Bell, Timothy J.

AU - Fisher, Elizabeth A.

AU - Blakeman, Bradford P.

AU - Bakhos, Mamdouh

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N2 - Background. Diffuse or unresectable subaortic stenosis (SAS) necessitates an aggressive surgical approach for the elimination of left ventricular outflow tract obstruction. In this article we report our experience with the modified Konno-Rastan procedure, with inherent preservation of the native aortic valve and annulus, in the treatment of diffuse or unresectable SAS. Methods. Sixteen children (age range, 21 months to 18 years) underwent the modified Konno-Rastan procedure through either a transventricular (n = 12) or a transatrial approach (n = 4) to the conal septum. Indications for operation were recurrent SAS (n = 3), hypertrophic obstructive cardiomyopathy (n = 3), tunnel stenosis (n = 2), SAS related to a canal (n = 3), and SAS after ventricular septal defect closure (n = 5). Eleven patients had undergone previous procedures and 5 underwent the modified Konno-Rastan procedure as their primary operation. Results. The mean preoperative left ventricular outflow tract gradient of 50 ± 17 mm Hg was reduced to 3 ± 7 mm Hg (p <0.001) after surgical repair. Postoperative complications included sternal infection (n = 1), heart block (n = 2), mediastinal bleeding (n = 1), and renal and cerebral ischemia (n = 1). There was 1 late postoperative death caused by pneumonia 2 years after operation (6.2% mortality rate). The mean follow-up period was 62 ± 39 months and all patients had complete relief of preoperative symptoms and were in New York Heart Association class I. One patient underwent a successful redo modified Konno-Rastan procedure 7 years after the first operation for residual left ventricular outflow tract obstruction immediately below the aortic valve. One patient is awaiting reoperation for aortic incompetence unrelated to conal enlargement 1.5 years after the first procedure. Conclusions. The modified Konno-Rastan procedure represents an excellent therapy for diffuse or unresectable SAS in patients with a normal aortic valve. In addition, it produces excellent results in a limited number of patients with hypertrophic obstructive cardiomyopathy, in whom the Morrow procedure traditionally has been performed. Although it usually is performed through a transventricular approach, the modified Konno-Rastan procedure also can be performed through a transatrial approach; this is particularly useful in patients who have had previous ventricular septal defect closure associated with SAS occurring proximal to the prosthetic patch.

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