Aortic annular enlargement is frequently necessary for the young patient with a small aortic annulus undergoing mechanical valve replacement. The Konno procedure was introduced to allow aortic valve replacement with an adequate sized mechanical valve for patients with a small aortic annulus.
1A heart with concordant atrioventricular and ventrieu-loarterial relation has an anatomical benefit whereby the left ventricular outflow tract makes a right angle with the right ventricular outflow tract. Therefore, a longitudinal incision in the aortic root and a transverse incision in the right ventricular outflow tract make a straight line. When an aortic valve replacement is necessary in combination with annular enlargement the Konno proceilure is the surgery of choice.
- Konno S
- Imai Y
- Lida Y
- et al.
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
Using standard cardiopulmonary bypass with moderate hypothermia and antegrade and/or retrograde cold cardioplegia, the aortic valve is inspected through a longitudinal incision in the aortic wall. If the valve is not repairable, it is excised for valve replacement and the annular size is measured.
After the Ross procedure
2was revived in the 1980s and aortic and pulmonary homografts became available, the Ross procedure evolved to be the procedure of choice for young patients who need aortic valve replacement with annular enlargement. Therefore, the classic Konno procedure is not usually the procedure of first choice for aortic annular enlargement in children. However, on occasion, homografts may be unavailable for right ventricular tract reconstruction. Another situation where the classic Konno procedure may be preferred is in the patient who has previously undergone closure of a subarterial ventricular septal defect close to the pulmonary annulus. Under these circumstances the pulmonary valve may not be suitable for use in a Ross procedure.
- Ross DN
- Jackson M
- Davis J
Pulmonary autograft aortic valve replacement: Long term results.
J Card Surg. 1991; 6: 529-533
The concept of the Konno procedure in which the left ventricular outflow tract is enlarged by an incision from the aortic root into the left ventricular outflow tract has been applied in conjunction with the Ross procedure and has been called the Ross-Konno procedure.
- Reddy VM
- Rajasinghe HA
- Teitel DF
- Haas GS
- Hanley FL
Aortoventriculoplasty with the pylmonary autograft: The “Ross-Konno” procedure.
J Thorac Cardiovasc Surg. 1996; 111: 158-167
The Konno aortoventriculoplasty has been reported to be a good surgical option for complex left ventricular outflow tract obstruction. Freedom from reoperation for the mechanical valve has been reported as 80% at 10 years and 52% at 15 years. In the experience of the Heart Institute of Japan, 60 patients underwent a Konno procedure with a mechanical valve between May 1984 and December 2000. The ages ranged from 2 to 37 years old with an average age of 11.6 years. There were no hospital deaths with five late deaths. There have been only two reoperations.
- 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
- Pulmonary autograft aortic valve replacement: Long term results.J Card Surg. 1991; 6: 529-533
- Aortoventriculoplasty with the pylmonary autograft: The “Ross-Konno” procedure.J Thorac Cardiovasc Surg. 1996; 111: 158-167
- Konno aortoventriculoplasty in children and adolescents: From prosthetic valves to the Ross operation.Ann Thorac Surg. 2000; 74: 122-126
© 2002 Elsevier Inc. Published by Elsevier Inc.
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