Modified Konno procedure

The tunnel-type aortic stenosis is a tubular stenosis that extends from the lower aortic annulus to a length of 10 to 30 mm. It is relatively rare. It is possible to combine small aortic rings at the same time. Some authors use the term diffuse subaortic stenosis to describe such deformities. However, diffuse aortic stenosis is sometimes confused with hypertrophic obstructive cardiomyopathy, and it is recommended to avoid application. Simple tunnel aortic stenosis can be used for left ventricular outflow tract incision and patch widening correction. Simple ventricular septal incision and patch widening angioplasty are also called ventricular septal angioplasty. Treatment of diseases: congenital aortic coarctation Indication Improved Konno surgery is available for: It is suitable for tunnel aortic stenosis with normal aortic valve and annulus, and is also suitable for some difficult or recurrent aortic subvalvular stenosis. Preoperative preparation In addition to general routine procedures for open heart surgery, two-dimensional echocardiography and color Doppler examination should be performed before surgery to understand the pathological anatomy of the aortic valve, the size of the annulus and left ventricle, and whether or not the aortic regurgitation is combined. The extent of this in order to choose the appropriate surgical approach. Attention should be paid to monitoring the circulation, respiration and metabolism of critically ill infants before surgery. In the case of cardiac insufficiency, patients should be treated with diuretic diuresis. If necessary, positive inotropic drugs should be given. Newborn patients with critical illness need emergency treatment. Once the diagnosis is established, the prostaglandin E1 should be administered first through the central vein, the arterial catheter should be opened, and the right-to-left shunt of the transcatheter can be restored, which can reduce pulmonary hypertension and maintain systemic perfusion, so that it can be obtained from systemic low perfusion and acidosis. ease. These infants often need tracheal intubation and mechanical ventilation, and appropriate application of vasoactive drugs such as dopamine can help improve respiratory and circulatory function. Surgical procedure 1. Make a transverse incision in the ascending aorta root and examine the aortic valve. 2. Make a transverse incision 2 cm from the pulmonary artery in the right ventricular funnel. 3. Apply right angle forceps or the operator's index finger into the left ventricular outflow tract through the aortic valve, 1cm below the aortic valve or through the stenosis plane to the chamber interval, from the right ventricular cavity for ventricular septal percussion, and at that place Parallel left ventricular outflow tract longitudinally incision ventricular septum. 4. Retract the ventricular septal incision, examine the left ventricular outflow tract, and remove as much as possible the abnormal fibromuscular tissue that causes the subaortic stenosis. 5. Apply an appropriate size of oval polyester sheet or 0.6% glutaraldehyde-treated autologous pericardium sheet, and use a small shim with intermittent suture to suture from the left ventricle to the right ventricle, and intermittently fix the patch 4 to 5 needles. The patch was then inserted into the interventricular septum by continuous suture to widen the left ventricular outflow tract. 6. Continuous suture of the right ventricle and aortic incision. If a right ventricular outflow tract is suspected or a right ventricular outflow tract stenosis is created after suturing, another autologous pericardial piece can be used to suture and widen the right ventricular outflow tract. 7. Exclude the heart cavity, open the ascending aorta obstruction forceps, induce the heart to rebound, then gradually stop the extracorporeal circulation, and close the chest as usual.