V. Mohan Reddy, MDa(by invitation), Hiranya A

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Presentation transcript:

Aortoventriculoplasty with the pulmonary autograft: The "Ross-Konno" procedure V.Mohan Reddy, MDa(by invitation), Hiranya A. Rajasinghe, MDa(by invitation), David F. Teitel, MDb(by invitation), Gary S. Haas, MDa(by invitation), Frank L. Hanley, MDa(by invitation) The Journal of Thoracic and Cardiovascular Surgery Volume 111, Issue 1, Pages 158-167 (January 1996) DOI: 10.1016/S0022-5223(96)70412-9 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Angiogram of a 3 ½-month-old infant who underwent a balloon aortic valvotomy. Significant residual stenosis and progressive aortic insufficiency resulted in severe left ventricular dysfunction. Top frame shows the diastolic appearance of the dilated left ventricle with thickened bicuspid aortic valve. Bottom frame shows the systolic appearance of the poorly contracting left ventricle. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 158-167DOI: (10.1016/S0022-5223(96)70412-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Angiogram of a 3 ½-month-old infant who underwent a balloon aortic valvotomy. Significant residual stenosis and progressive aortic insufficiency resulted in severe left ventricular dysfunction. Top frame shows the diastolic appearance of the dilated left ventricle with thickened bicuspid aortic valve. Bottom frame shows the systolic appearance of the poorly contracting left ventricle. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 158-167DOI: (10.1016/S0022-5223(96)70412-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Angiogram of a 4.2-month-old infant who had a suboptimal result from balloon aortic valvotomy in the neonatal period. Systolic frame shows severely hypertrophied left ventricle with long-segment subaortic obstruction. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 158-167DOI: (10.1016/S0022-5223(96)70412-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Technique of Ross-Konno procedure. A, The dashed lines indicate the lines of incision along which the autograft pulmonary valve is harvested, the ascending aorta (Ao) is transected, and coronary buttons are developed. RPA, Right pulmonary artery; LPA, left pulmonary artery; MPA, main pulmonary artery; APV, pulmonary autograft; RC, right coronary button. B, The pulmonary autograft is harvested. Large coronary buttons are developed and diseased aortic valve is excised up to the anulus. The dashed line indicates the site of the septal incision for ventriculoplasty. LC, Left coronary button; IMPatch, infundibular free wall muscle flap used for aortoventriculoplasty; AAnn, aortic anulus; IVS, interventricular septum; K, site of septal incision. C, Pulmonary autograft is seated with the suture line starting posteriorly and continuing along the anulus onto the interventricular septum. D, Pulmonary autograft in place with reimplanted coronary artery buttons. E, allograft conduit (AC) sutured directly to the right ventricle without the use of additional patch material. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 158-167DOI: (10.1016/S0022-5223(96)70412-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Technique of Ross-Konno procedure. A, The dashed lines indicate the lines of incision along which the autograft pulmonary valve is harvested, the ascending aorta (Ao) is transected, and coronary buttons are developed. RPA, Right pulmonary artery; LPA, left pulmonary artery; MPA, main pulmonary artery; APV, pulmonary autograft; RC, right coronary button. B, The pulmonary autograft is harvested. Large coronary buttons are developed and diseased aortic valve is excised up to the anulus. The dashed line indicates the site of the septal incision for ventriculoplasty. LC, Left coronary button; IMPatch, infundibular free wall muscle flap used for aortoventriculoplasty; AAnn, aortic anulus; IVS, interventricular septum; K, site of septal incision. C, Pulmonary autograft is seated with the suture line starting posteriorly and continuing along the anulus onto the interventricular septum. D, Pulmonary autograft in place with reimplanted coronary artery buttons. E, allograft conduit (AC) sutured directly to the right ventricle without the use of additional patch material. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 158-167DOI: (10.1016/S0022-5223(96)70412-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Technique of Ross-Konno procedure. A, The dashed lines indicate the lines of incision along which the autograft pulmonary valve is harvested, the ascending aorta (Ao) is transected, and coronary buttons are developed. RPA, Right pulmonary artery; LPA, left pulmonary artery; MPA, main pulmonary artery; APV, pulmonary autograft; RC, right coronary button. B, The pulmonary autograft is harvested. Large coronary buttons are developed and diseased aortic valve is excised up to the anulus. The dashed line indicates the site of the septal incision for ventriculoplasty. LC, Left coronary button; IMPatch, infundibular free wall muscle flap used for aortoventriculoplasty; AAnn, aortic anulus; IVS, interventricular septum; K, site of septal incision. C, Pulmonary autograft is seated with the suture line starting posteriorly and continuing along the anulus onto the interventricular septum. D, Pulmonary autograft in place with reimplanted coronary artery buttons. E, allograft conduit (AC) sutured directly to the right ventricle without the use of additional patch material. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 158-167DOI: (10.1016/S0022-5223(96)70412-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Technique of Ross-Konno procedure. A, The dashed lines indicate the lines of incision along which the autograft pulmonary valve is harvested, the ascending aorta (Ao) is transected, and coronary buttons are developed. RPA, Right pulmonary artery; LPA, left pulmonary artery; MPA, main pulmonary artery; APV, pulmonary autograft; RC, right coronary button. B, The pulmonary autograft is harvested. Large coronary buttons are developed and diseased aortic valve is excised up to the anulus. The dashed line indicates the site of the septal incision for ventriculoplasty. LC, Left coronary button; IMPatch, infundibular free wall muscle flap used for aortoventriculoplasty; AAnn, aortic anulus; IVS, interventricular septum; K, site of septal incision. C, Pulmonary autograft is seated with the suture line starting posteriorly and continuing along the anulus onto the interventricular septum. D, Pulmonary autograft in place with reimplanted coronary artery buttons. E, allograft conduit (AC) sutured directly to the right ventricle without the use of additional patch material. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 158-167DOI: (10.1016/S0022-5223(96)70412-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Technique of Ross-Konno procedure. A, The dashed lines indicate the lines of incision along which the autograft pulmonary valve is harvested, the ascending aorta (Ao) is transected, and coronary buttons are developed. RPA, Right pulmonary artery; LPA, left pulmonary artery; MPA, main pulmonary artery; APV, pulmonary autograft; RC, right coronary button. B, The pulmonary autograft is harvested. Large coronary buttons are developed and diseased aortic valve is excised up to the anulus. The dashed line indicates the site of the septal incision for ventriculoplasty. LC, Left coronary button; IMPatch, infundibular free wall muscle flap used for aortoventriculoplasty; AAnn, aortic anulus; IVS, interventricular septum; K, site of septal incision. C, Pulmonary autograft is seated with the suture line starting posteriorly and continuing along the anulus onto the interventricular septum. D, Pulmonary autograft in place with reimplanted coronary artery buttons. E, allograft conduit (AC) sutured directly to the right ventricle without the use of additional patch material. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 158-167DOI: (10.1016/S0022-5223(96)70412-9) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Angiogram of a 3-day-old patient. Note the severely hypertrophied hypoplastic left ventricle. The calculated (by echo) left ventricular end-diastolic volume was 12 to 16 ml/m2. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 158-167DOI: (10.1016/S0022-5223(96)70412-9) Copyright © 1996 Mosby, Inc. Terms and Conditions