The Ross-Konno procedure for congenital aortic stenosis

Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients.We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was performed, and within 8 months the patient developed recurrent symptoms of severe aortic stenosis. He underwent redo sternotomy and a Ross-Konno procedure with an uneventful recovery.

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A Novel Approach: Trans-ascending Aorta Balloon Aortic Valvuloplasty via Sternotomy for Treating Severe Valvular Aortic Stenosis in a Low-Weight Infant

The Heart Surgery Forum ◽

10.1532/hsf98.2013277 ◽

2014 ◽

Vol 17 (1) ◽

pp. 25 ◽

Cited By ~ 1

Author(s):

Lei Gao ◽

Qin Wu ◽

Xinhua Xu ◽

Tianli Zhao ◽

Wancun Jin ◽

...

Keyword(s):

Aortic Stenosis ◽

Transesophageal Echocardiography ◽

Severe Aortic Stenosis ◽

Ascending Aorta ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Novel Approach ◽

Low Weight ◽

Aortic Valvuloplasty ◽

Peak Gradient

Background: Severe congenital aortic stenosis in infants is a life-threatening congenital heart anomaly that is typically treated using percutaneous balloon aortic valvuloplasty.Methods: The usual route is the femoral artery under radiographic guidance. However, this procedure may be limited by the small size of the femoral artery in low-weight infants. An infant weighing only 7 kg with severe aortic stenosis (peak gradient was 103 mmHg) was successfully treated with a novel approach, that is trans-ascending aorta balloon aortic valvuloplasty guided by transesophageal echocardiography.Results: The patient tolerated the procedure well, and no major complications developed. After the intervention, transesophageal echocardiography indicated a significant reduction of the aortic valvular peak gradient from 103 mmHg to 22 mmHg, no aortic regurgitation was found. Eighteen months after the intervention, echocardiography revealed that the aortic valvular peak gradient had increased to 38 mmHg and that still no aortic regurgitation had occurred.Conclusions: In our limited experience, trans-ascending aorta balloon aortic valvuloplasty for severe aortic stenosis under transesophageal echocardiography guidance effectively reduces the aortic peak gradient. As this is a new procedure, long-term follow up and management will need to be established. It may be an alternative technique to treat congenital aortic stenosis in low-weight patients.

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Faculty Opinions recommendation of Sudden unexpected death after balloon valvuloplasty for congenital aortic stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.8343956.8782055 ◽

2011 ◽

Author(s):

Larry Latson ◽

Athar Qureshi

Keyword(s):

Aortic Stenosis ◽

Sudden Unexpected Death ◽

Balloon Valvuloplasty ◽

Unexpected Death ◽

Congenital Aortic Stenosis

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Valve-sparing operation for balloon-induced aortic regurgitation in congenital aortic stenosis

Journal of Thoracic and Cardiovascular Surgery ◽

10.1067/mtc.2001.114639 ◽

2001 ◽

Vol 122 (1) ◽

pp. 162-168 ◽

Cited By ~ 29

Author(s):

Emile A. Bacha ◽

Gary M. Satou ◽

Adrian M. Moran ◽

David Zurakowski ◽

Gerald R. Marx ◽

...

Keyword(s):

Aortic Stenosis ◽

Aortic Regurgitation ◽

Congenital Aortic Stenosis ◽

Valve Sparing

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Abstract 19440: Reintervention Rates Following Balloon Aortic Valvuloplasty versus Surgical Valve Repair in Isolated Congenital Aortic Valve Stenosis - A Meta-analysis

Circulation ◽

10.1161/circ.132.suppl_3.19440 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

May T Saung ◽

Courtney McCracken ◽

Ritu Sachdeva ◽

Christopher J Petit

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Stenosis ◽

Meta Analysis ◽

Valve Repair ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Primary Indication ◽

Aortic Valvuloplasty

Introduction: The optimal treatment for congenital aortic stenosis (AS) is debated despite decades of experience with both balloon aortic valvuloplasty (BAV) and surgical aortic valve repair (SAV). While BAV has been the mainstay of therapy for AS, recent single-center reports suggest optimal results following SAV. Hypothesis: We propose that reintervention rates following SAV and BAV are equivalent. Methods: We queried Medline, EMBASE and Web of Science for eligible studies using the keywords: “congenital aortic stenosis”, “balloon valvotomy”, “aortic valve stenosis surgery” and “treatment outcome or reintervention”. Studies were excluded when cohort size was <20 pts, when follow-up was < 2.5 yrs from primary intervention, and when primary indication was not AS (e.g. SAV in the setting of aortic valve regurgitation (AR)). Outcomes analyzed included death, reintervention and moderate or severe AR. Analysis was performed using Comprehensive Meta Analysis v3 using random effects models. Results: A total of 20 studies were included in our meta-analysis: SAV alone (n=3), BAV alone (n=12), and both (n=5). The mean age at BAV was 3.1 years (range, 4 days - 7 years) with a mean follow-up duration of 6.8 years, while mean age at SAV was 2.8 years (range, 14.2 days - 7.1 years) with a mean follow-up duration of 9.1 years. Mortality rates following BAV and SAV were 12.3% (95% CI: 7.7 - 19.1) and 10.2% (95% CI: 7.0 - 14.5), respectively (p=0.27). Reintervention following initial procedure for treatment of AS was higher following BAV (35.7% [95% CI: 29 - 43.1]) compared to SAV (25.2% [95% CI: 19.9 - 31.3])(p=0.012). Long-term and mid-term follow-up in these studies showed moderate to severe AR was present in 24.1% and 28.1% of BAV and SAV patients, respectively. Conclusions: Notwithstanding publication bias, both survival rates and development of late AR following BAV and SAV are similar. However, reintervention rates are significantly higher following BAV compared to SAV.

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Gradient reduction, aortic valve regurgitation and prolapse after balloon aortic valvuloplasty in 32 consecutive patients with congenital aortic stenosis

Journal of the American College of Cardiology ◽

10.1016/0735-1097(90)90601-k ◽

1990 ◽

Vol 16 (2) ◽

pp. 451-456 ◽

Cited By ~ 49

Author(s):

Robert E. Shaddy ◽

Mark M. Boucek ◽

Jane E. Sturtevant ◽

Herbert D. Ruttenberg ◽

Garth S. Orsmond

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Valve Regurgitation ◽

Aortic Valve Regurgitation ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Aortic Valvuloplasty

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Medium term follow-up after balloon dilatation of congenital aortic stenosis (AVBD) in children

Heart Lung and Circulation ◽

10.1046/j.1443-9506.2003.0343x.x ◽

2003 ◽

Vol 12 (2) ◽

pp. A90

Author(s):

Nageswara R. Koneti ◽

Gary F. Sholler ◽

Stephen Cooper ◽

Richard E. Hawker

Keyword(s):

Aortic Stenosis ◽

Balloon Dilatation ◽

Medium Term ◽

Congenital Aortic Stenosis

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Echocardiography in Aspergillus Endocarditis

PEDIATRICS ◽

10.1542/peds.69.2.252 ◽

1982 ◽

Vol 69 (2) ◽

pp. 252-253

Author(s):

Martin B. Kleiman

Keyword(s):

Case Report ◽

Aortic Stenosis ◽

Mycotic Aneurysm ◽

Two Dimensional ◽

Congenital Aortic Stenosis

In an extensive review1 of endocarditis caused by Aspergillus in children, Barst et al found no cases in which the presence of vegetations was proven by echocardiography. We present the case report of a child in whom the two-dimensional echocardiogram first established the presence of a mycotic aneurysm and associated intracardiac and intra-aortic vegetations. Case Report. An 11-year-old girl with severe congenital aortic stenosis underwent aortic valvulotomy on Dec 17, 1977. Fever developed on the 11th day after surgery and daily spikes to 38.8 C (102 F) continued for the ensuing several weeks.

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