Modified Konno-Rastan Procedure for Subaortic Stenosis: Indications, Operative Techniques, and Results

Left Ventricular Outflow Tract Obstruction

“…The right ventriculotomy can be closed primarily or with a patch. Satisfactory reduction of the LVOT gradient from 50 to 3 mmHg, and a relatively low operative mortality rate (6.2% at 2 years) have been reported [161].…”

“…When there is a well-developed aortic valve of adequate size, a septal ventriculoplasty (modified Konno-Rastan procedure) is the preferred option (Figure 30.4) [37,160,161]. The interventricular septum is exposed through an incision made in the pulmonary infundibulum.…”

Surgical Management of Left Ventricular Outflow Tract Obstruction

“…At the most complex end of the spectrum, there is the diffuse, tunnel‐like form of LVOTO. Conventional transaortic resection fails to achieve satisfactory long‐term results and tunnel LVOTO requires aggressive surgical approaches such as aorticoventriculoplasty (the Konno procedure) or aortic root replacement with pulmonary autograft and ventriculoplasty (the Ross‐Konno procedure) for relief of subaortic obstruction 8–12 …”

Surgical correction of subaortic stenosis via right ventriculotomy and septal resection in a dog

“…15 In a study 6 of 44 dogs with severe SAS that were treated surgically via an aortotomy, the systolic pressure gradient was reduced by 45% to 65%, suggesting incomplete removal of the obstruction. 6,16 In humans, aortotomy provides better exposure of the left ventricular outflow tract than it does in dogs. Additionally, the membranous ring form of obstruction found commonly in humans is easier to remove than the fibrocartilaginous ring that develops in dogs with SAS.…”

“…In humans, this approach is routinely used without damage to the cardiac conduction pathway. [16][17][18] Because left ventricular hypertrophy is caused by the increased workload imposed by the obstruction in dogs with SAS, 19 the degree of resolution of concentric left ventricular hypertrophy achieved postoperatively may be important in determining the long-term effectiveness of the surgery. Although substantial left ventricular mass regression occurred in the dog of this report, the importance of this factor with regard to survival rates and times and as a long-term indicator of surgical success has not been studied.…”