Regression of hypertrophic cardiomyopathy after modified konno procedure

Management of Complex Left Ventricular Outflow Tract Obstruction: A Comparison of Konno and Modified Konno Techniques

“…Left ventricular outflow tract (LVOT) abnormalities represent 1-2% of all congenital anomalies. Most common known associations of LVOT obstruction (LVOTO) include (a) hypertrophic cardiomyopathy, (b) interrupted aortic arch, hypoplastic aortic arch, coarctation of the aorta, with or without ventricular septal defects, and (c) atrioventricular canal defects, particularly in certain unbalanced forms of atrioventricular canal defects [1][2][3][4][5]. Treatment options have evolved over time: less complicated forms of LVOTO may only require subaortic stenosis (SubAS) resection, while the more complex forms may benefit from a Modified Konno procedure with preservation of the native aortic valve, or the Konno procedure, which involves aortic valve replacement (with autograft or prosthetic valve) as part of LVOT enlargement [6,7].…”

“…This procedure has proven to be effective in the surgical management of small aortic annuli with multilevel LVOTO and recurrent SubAS. It is employed less often for LVOTO following Rastelli-type operations for transposition of the great arteries, LVOTO in patients with hypertrophic cardiomyopathy, and tunnel-like forms of SubAS [2,[9][10][11][12][13][14][15]. The Modified Konno procedure is also performed to treat LVOTO, but differs from the Konno procedure in that it is intended to preserve the native aortic valve [16].…”

Valve-Sparing Konno and Hypertrophic Obstructive Cardiomyopathy in Children

“…It is thus particularly indicated in severe forms of HOCM. 7 Since 1990, the modified Konno operation is our procedure of choice in children with HOCM. 8,9 Associated mitral valvuloplasty to correct severe systolic anterior motion of the mitral valve is performed in selected cases, using the retention plasty technique, as described by Delmo Walter et al 10 Implantation of an epicardial cardiac defibrillator is also carried out, if indicated (history of syncope or sudden death presumably related to arrhythmia, very severe ventricular septal thickness, and a positive family history of sudden death) (Figs.…”

EDITORIAL COMMENT: Operation and Failure

“…Several surgical operations and interventions appear to be efficacious in reducing left ventricular outflow tract obstruction in HOCM: left ventriculoseptal myotomy and myectomy (the Morrow procedure), 2 the modified Konno procedure, 3 mitral valve replacement, 4 and more recently ASR, 5 covered stent implantation in the left anterior descending coronary artery, 6 and perhaps some pacing modalities 7–9 . While the indication for surgery is refractory symptoms, data exist suggesting that the Morrow procedure may reduce mortality 10 .…”