The modified Konno procedure for complex left XXXX .

@entity1 @entity82 @entity3585 @entity886 @entity1757 @entity337 @entity204 @entity616
BACKGROUND: Complex left ventricular outflow tract (LVOT) obstruction with normal @entity886 requires aggressive resection in the subaortic region and preservation of the aortic valve. The modified Konno procedure allows generous exposure of the LVOT from the left ventricular apex to the inter leaflet trigones of the aortic valve. Widespread use of this procedure has been limited by concern over injury to the aortic valve, the conduction system, and possibility of residual @entity1757 ( @entity1757 ). METHODS: Retrospective analysis of pertinent data for all @entity1 undergoing the modified Konno procedure (1994 to 2001) at the University of Iowa were reviewed. RESULTS: The modified Konno procedure was used in 18 @entity1 (age 1 to 31) for @entity3585 associated with diffuse narrowing of the LVOT (n = 7), a discrete @entity82 (n = 7), or a @entity82 associated with abnormal mitral attachments (n = 4). Eight @entity1 had previously undergone LVOT resection. There were no perioperative @entity204 . Estimated LVOT peak gradients by echocardiogram were 70.4 +/- 24.2 mm Hg (preoperative) and 19.2 +/- 20.4 mm Hg (postoperative) at most recent followup (p < 0.001 vs preop). @entity337 was moderate in one @entity1 (present preop) and mild or less in all other @entity1 . There were no cases of permanent @entity616 . Small residual VSDs were present in five @entity1 (28%). Median follow-up is 3.1 years. CONCLUSIONS: The modified Konno procedure can effectively relieve complex @entity3585 and preserve @entity886 . Extension of this procedure for use in the initial presentation of LVOT may be appropriate in cases at increased risk of recurrent @entity3585 .
