Modified Konno Procedure for left ventricular outflow tract obstruction: report of two cases

Abstract

Left ventricular outflow tract obstruction with a systolic anterior motion of the mitral valve is a challenging pathology. An intervention, either surgically or with a percutaneous technique is taken into consideration when the pressure gradient reaches critical levels. Subaortic myectomy is still the gold standard treatment modality in these particular patients. Modified Konno procedure may be added to the procedure when a significant gradient persists following subaortic resection, because of its association with increased outflow tract obstruction relief. We herein present our experiences with two cases that underwent modified Konno procedures for the treatment of hypertrophic obstructive cardiomyopathy.

Keywords

• Left Ventricular Outflow Tract Obstruction
• Hypertrophic Obstructive Cardiomyopathy
• Surgical Treatment
• Modified Konno Procedure

References

1. Akçevin A, Sarıoğlu T, Süzer K, Polat B, Sarıoğlu A, Aytaç A. Subaortik stenozların cerrahi tedavisinde yeni bir yöntem: Modifiye Konno ameliyatı. Türk Göğüs Kalp Damar Cer Derg. 1991;1:63-7.
2. Metton O, Ali WB, Raisky O, Vouhe PR. Modified Konno operation for diffuse subaortic stenosis. Multimedia Manual of Cardio Thoracic Surgery. 2008 Jan 1.https://doi.org/10.1510/mmcts.2008.003426.
3. Henry WL, clark CE, epstein SE. Asymmetric septal hypertrophy: echocardiographic identification of the pathognomonic anatomic abnormality of IHSS. Circulation. 1973 Feb;47(2):225-33. https://doi.org/10.1161/01.cir.47.2.225
4. Norrish, Gabrielle, and Juan Pablo Kaski. “Congenital heart disease: An ageing problem.” British Journal of Cardiology 25.2 (2018): 46-47. https://doi.org/10.5837/bjc.2018.015
5. Mitevksa IP. Focus on echocardiography in hypertrophic cardiomyopathy-fourth in series. Article eJ ESC Council Cardiol Practice. 2015;13:20-14.
6. Bichell DP. Modified Konno procedure for left ventricular outflow tract obstruction. Operative Techniques in Thoracic and Cardiovascular Surgery. 2011 Mar 1;16(1):62-9. https://doi.org/10.1053/j.optechstcvs.2010.09.001
7. Cooley DA, Garrett JR. Septoplasty for left ventricular outflow obstruction without aortic valve replacement: a new technique. The Annals of thoracic surgery. 1986 Oct 1;42(4):445-8. https://doi.org/10.1016/s0003-4975(10)60556-5
8. Kouchoukos NT, Blackstone EH, Hanley FL, Kirklin JK. Kirklin/Barratt-Boyes Cardiac Surgery E-Book. Elsevier Health Sciences; 2012 Sep 27.

9. Rastan H, Koncz J. Aortoventriculoplasty: a new technique for the treatment of left ventricular outflow tract obstruction. The Journal of thoracic and cardiovascular surgery. 1976 Jun 1;71(6):920-7.
10. Misbach GA, Turley K, Ullyot DJ, Ebert PA. Left ventricular outflow enlargement by the Konno procedure. The Journal of Thoracic and Cardiovascular Surgery. 1982 Nov 1;84(5):696-703.
11. Vouhè PR, Poulain H, Bloch G, Loisance DY, Gamain J, Lombaert M, Quiret JC, Lesbre JP, Bernasconi P, Piètri J, Cachera JP. Aortoseptal approach for optimal resection of diffuse subvalvular aortic stenosis. The Journal of Thoracic and Cardiovascular Surgery. 1984 Jun 1;87(6):887-93.