Konno surgery

If the tunnel-type aortic stenosis, combined with aortic annulus dysplasia, the application of ventricular septal surgery is difficult to remove the obstruction. In 1975, Konno applied aortic-ventricular angioplasty successfully. Subsequently, Berhard et al. proposed apical-aortic bypass and aortic root replacement with the same type of aortic valve replacement with widening of the left ventricular outflow tract. Treatment of diseases: aortic stenosis Indication Konno surgery is suitable for aortic subvalvular stenosis with aortic annulus or aortic stenosis, when aortic valve replacement is required. 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 Moderate stenosis cases can be treated according to general open heart surgery, general anesthesia tracheal intubation, artificial ventilation to maintain breathing, and surgery to take supine position. Do not apply vasodilators in severely stenotic cases, taking care to prevent hypotension and affect coronary perfusion flow. 1. Establish extracorporeal circulation as usual, and the body temperature drops to 25 °C. 2. Make a longitudinal incision at the lower end of the ascending aorta and extend to the aortic annulus, which is 5 to 7 mm to the left of the origin of the right coronary artery. The incision is slightly to the left and extends below the pulmonary valve to the anterior wall of the right ventricular outflow tract. on. 3. Retract the right ventricle incision, apply a pair of scissors to the left ventricle through the aortic valve, and place the right ventricular incision on the other. Place the knife on the left side of the base of the right coronary valve and cut it directly under the tunnel. This broadens the aortic root and left ventricular outflow tract. 4. Excision of the aortic valve, measurement of the annulus to be enlarged, and selection of an artificial valve of appropriate size. The posterior segment of the artificial valve suture ring was sutured to the aortic annulus, and the pre-coagulated polyester patch was applied, cut into a diamond shape and appropriately sized, and the lower end of the patch was sutured with a small spacer using a 3-0 non-invasive suture. Or continuous suture to widen the ventricular septal incision to the level of the aortic annulus. 5. Apply intermittent suture suture, suture the artificial aortic valve front suture ring directly on the polyester patch, and ligation one by one. (Cut the remaining patch into appropriate shape and size, and use continuous suture to close the aortic incision . 6. Trim a piece of triangular pericardium tissue or polyester fabric to close and widen the right ventricular outflow tract. The patch can be sutured to the right ventricular incision margin by continuous suture, reaching the aortic annulus plane above the patch. The front patch is directly sutured.