The Longest Functioning Apical Left Ventricular to Descending Aortic Valve Conduit

Abstract

A 36-year-old woman has had an apical left ventricular to descending aortic valve conduit for 24 years that is functioning well and that is probably, to our knowledge, the longest surviving conduit. The patient had previously had a coarctation of the aorta resected at 2 years of age. In 1978, a prosthetic valve conduit was inserted through a left thoracotomy to relieve the left ventricular outflow tract obstruction caused by a monocusp aortic valve and hypoplastic aortic arch. Using cardiopulmonary bypass between the left atrium and the descending thoracic aorta, the apical aortic conduit was placed with a number 19 Hancock elbow-shaped ventricular splint at the apex of the left ventricle, and this was in turn attached to a number 20 Hancock valve conduit anastomosed to the descending aorta, just above the diaphragm. Recent angiography demonstrated no conduit stenosis or regurgitation. The computed tomography images are quite unique and showed the conduit from the left ventricular apex (Fig 1A, arrow) to the descending aorta (Fig 1B). The patient has limited exercise capacity requiring diuretics, and arrhythmia controlled with amiodarone. Despite the reported high incidence of conduit stenosis, apical left ventricular to aorta conduit can produce a good hemodynamic outcome and may be suitable for patients with severe hypertrophic subaortic stenosis thought unsuitable for Morrow’s operation or patients with critical aortic stenosis and “porcelain” ascending aorta. Address reprint requests to Dr Tsang, Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond St, London WC1N 3JH, UK; e-mail: tsangv@gosh.nhs.uk. Fig 1.