Mid-to-long Term Results of the Aortoventriculoplasty Operation in Left Ventricular Outflow Tract Obstructions

Tayyar SAĞIROĞLU, Murat MERT, M. Salih BİLAL, Tijen ALKAN, İhsan BAKIR, *Ayşe SARIOĞLU,**Atıf AKÇEVİN,***Özge KÖNER

İstanbul Üniversitesi, Kardiyoloji Enstitüsü, Kalp ve Damar Cerrahisi Anabilim Dalı
* Vehbi Koç Vakfı Amerikan Hastanesi, Kalp ve Damar Cerrahisi Departmanı
** İstanbul Üniversitesi Kardiyoloji Enstitüsü, Pediatrik Kardiyoloji Bilim Dalı
*** İstanbul Üniversitesi Kardiyoloji Enstitüsü, Anesteziyoloji ve Reanimasyon Anabilim Dalı

Congenital aortic stenosis occurs either at valvular, subvalvular or supravalvular level. Sometimes subvalvular stenosis may be associated to valvular aortic stenosis seen in childhood. Temporary relief may be achieved by balloon valvotomy and/or open aortic commissurotomy in these children during the newborn period. However, majority of these cases need an open intervention to the aorta due to the development of restenosis. Furthermore, a prosthetic aortic valve with an appropriate diameter may not be inserted by conventional aortic valve replacement techniques at these ages, thus an aortic root enlargement procedure is often required. Aortoventriculoplasty operations performed on the basis of enlarging both valvular and subvalvular area together enables the surgeon to enlarge the aortic annulus 1.5 to 2 times and play an important role in the treatment of these cases.

Mid to long term follow-up results of 5 patients who had undergone aortoventriculoplasty operation at 8 to 16 years of age in our clinic revealed that ali patients are in NYHA Class I functional capacity and the preoperative left ventricle-aorta gradient decreased from 119.8 mmHg to 20.8 mmHg while the aortic annulus diameter increased from 13.4 mm to 22.4 mm.

Based on the mid-to-tong follow-up results and on the aortic annulus enlargement together with the permanent decrease in the left ventricle to aorta gradient, we believe that aortoventriculoplasty operation should be taken into consideration in patients with combined stenosis of valvular and subvalvular aortic area.

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