Long-term results of aortoventriculoplasty

Abstract

AbstractObstruction of the left ventricular outflow tract continues to represent a challenging surgical problem, particularly in children. Failure to relieve the obstruction by either valvotomy or myectomy requires enlargement of the ventriculoaortic junction and outflow tract. Alternatively, the obstruction can be by passed using an apical valved veritriculo aortic conduit, althoughthis is associatedwith a high rate oflong-term complications. The use of a small xenograft in children is less than ideal because of early calcification, and the insertion of a mechanical valve may be feasible only after considerable enlargement of the ventriculoaortic junction. Aortoventriculoplasty is particularly suited for this purpose, and it is usually associated with good early results. Yet, long-term experience with this procedure, as far as we know, has not been reported previously. We describe our experience with the use of aortoventriculoplasty in four patients, three of whom have been followed-up for more than five years. Two patients have required reoperation for replacement of their prosthetic valves, one for bacterial endocarditis and the other for fracture of a continuous prolene suture which secured the prosthetic valve to the Dacron septal patch. All patients are currently in good health with continuing satisfactory relief of obstruction to their left ventricular outflow tract.