Classic Konno-Rastan procedure: Indications and results in the current era

Diffuse or unresectable subaortic stenosis is difficult to treat and needs aggressive resection to effectively relieve the obstruction. Anterior aortoventriculoplasty, known as the Konno-Rastan procedure, has been shown to effectively tackle the problems encountered in diffuse subaortic stenosis. A retrospective study was carried out on patients who had undergone a Konno-Rastan procedure at our institution from March 1997 to November 2003. There were 26 patients (16 males and 10 females). The mean age at operation was 12.8 ± 7 years. The mean follow-up period was 30.4 ± 14.5 months. Only mechanical valves were used in this group of patients. The overall 30-day mortality was 11.5 (3 patients). The mean preoperative peak systolic gradient decreased significantly from 91.3 ± 39.3 to 28.1 ± 17.7 mm Hg. Four patients developed permanent complete heart block and 2 had a residual ventricular septal defect in late follow-up. The classic Konno-Rastan procedure using a mechanical valve can be performed with acceptable morbidity and mortality in this difficult group of patients

Mortality and morbidity after aortic root replacement: 10-year experience

Aortic root reconstruction remains a challenging surgical procedure. This retrospective study was carried out to evaluate the early and long-term outcomes of aortic root replacement over a 10-year period. There were 83 patients with a mean age of 43.2 ± 14 years (range, 10 to 78 years). Type A aortic dissection and Marfan syndrome were found in 28 and 24, respectively. The most common technique used for repair of this condition was the Bentall operation. The mean duration of follow-up was 29.6 ± 28 months, ranging from 1 to 120 months. Hospital (30-day) mortality was 13.3 (11 patients). Two patients died during the late follow-up. The mortality was significantly higher in patients presenting with cardiogenic shock, those with long cardiopulmonary bypass and crossclamp times, and the group who had concomitant coronary artery bypass grafting. Emergency operation was not a significant risk factor for early death in our patients. The most common complications were bleeding and neurological sequelae. Aortic root replacement can be achieved with acceptable mortality and morbidity in a high-risk group of patients. Improvements in the outcome may be achieved by faster transport of patients in cardiogenic shock, and by reducing the cardiopulmonary bypass and crossclamp times

An Intracardiac Mass in a Pregnant Woman Presenting with Ventricular Tachycardia

A pregnant patient presented with symptomatic ventricular tachycardia. Echocardiography revealed a large intramyocardial mass. Surgical resection was attempted in conjunction with cryoablation of the surrounding myocardial tissue. Histologic examination of the resected mass revealed cardiac neurofibroma. To the best of our knowledge, this is the first report of cardiac neurofibroma in a pregnant patient in the absence of any neurocutaneous syndromes such as neurofibromatosis. © 2016 The Society of Thoracic Surgeons