Clinical Experience With the Use of a Valve-Bearing Conduit to Construct a Second Left Ventricular Outflow Tract In Cases of Unresectable Intra-Ventricular Obstruction

Abstract

Two patients, ages 7 and 17, with unresectable obstructions within the left ventricular cavity, have been managed by interposing a conduit bearing a porcine aortic valve between the apex of the left ventricle and the infra-renal abdominal aorta. The younger child had idiopathic hypertrophic subaortic stenosis (IHSS) recognized in infancy. At the age of three, a right ventricular myomectomy and a trans-aortic left ventricular myotomy were performed. Symptoms were progressive with congestive failure, diaphoresis, syncope , and angina pectoris. Following construction of a second left ventricular outflow tract with relief of intraventricular obstruction, the patient has become asymptomatic. The second patient has fibrous tunnel obstruction of the left ventricular outflow tracting providing a 100 mm Hg gradient. Fibrous tissue was resected in part through the transaortic route, and a second outflow tract was constructed. A postoperative cardiac catheterization revealed an obliteration of the previous intraventricular gradients and an equal distribution of left ventricular output through the two available outflow tracts. She remains asymptomatic.