P06.03: Measurement of the aortic outlet angle by ultrasound in fetuses with and without congenital heart malformations involving the left ventricular outflow tract

AbstractBetween 1981 and 1990, 765 symptomatic neonates with major congenital heart malformations were admitted into the Grantham Hospital. This represented an incidence of 10 per 10,000 live births for Hong Kong. The figure was comparable to those reported for Caucasians. Among the 744 Oriental neonates, obstruction of the pulmonary outflow tract occurred most frequently (281, 37.8%), followed by left ventricular outflow tract obstruction (169, 22.7%), left-to-right shunting (115, 15.5%), complete transposition (92, 12.4%), common mixing situations (62,8.3%), and miscellaneous causes (25, 3.3%). When compared with the available reports from the West, Chinese neonates had a high preference for pulmonary outflow tract obstruction (p<0.005), especially the anomaly of pulmonary atresia and intact ventricular septum. This correlated well with cyanosis as the commonest neonatal presentation (64%). Contrary to previous reports that aortic coarctation was rare among Orientals, this abnormality was observed frequently in our study. The rare occurrence of critical aortic valvar stenosis among Chinese, however, was supported by our present analysis. Other lesions, such as left-to-right shunting and complete transposition, showed no significant racial difference in the frequency of occurrence. Such knowledge concerning the pattern of congenital heart disease amongst Oriental neonates can facilitate early diagnosis and timely referral of babies to the appropriate center for management.

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Surgery for transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction: European Congenital Heart Surgeons Association multicentre study

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2010.03.030 ◽

2010 ◽

Vol 38 (6) ◽

pp. 699-706 ◽

Cited By ~ 43

Author(s):

Mark Gerard Hazekamp ◽

Alejandro Adsuar Gomez ◽

David R. Koolbergen ◽

Viktor Hraska ◽

Dominique R. Metras ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Multicentre Study ◽

Congenital Heart ◽

Septal Defect ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Ventricular Outflow Tract Obstruction ◽

Left Ventricular Outflow

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The Surgeon’s View of the Left Ventricular Outflow Tract in Congenital Heart Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120936632 ◽

2020 ◽

Vol 11 (5) ◽

pp. 595-610

Author(s):

Elizabeth H. Stephens ◽

Joseph A. Dearani ◽

Jonathan N. Johnson ◽

Michael J. Ackerman ◽

Steve R. Ommen ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Congenital Heart ◽

Heart Surgery ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Subaortic Stenosis ◽

Septal Myectomy ◽

Left Ventricular Outflow

Left ventricular outflow tract (LVOT) obstruction is a component of many forms of congenital heart disease, including hypertrophic cardiomyopathy, membranous subaortic stenosis, tunnel subaortic stenosis, and outflow tract obstruction related to atrioventricular septal defects. We have gained a particularly extensive experience with the diagnosis and treatment of hypertrophic cardiomyopathy, having performed septal myectomy in over 3,800 patients. In the setting of this review of LVOT obstruction, we use hypertrophic cardiomyopathy as a template by which other pathologies causing LVOT obstruction can be understood. We review important surgical issues in patient selection, diagnostic evaluation, interpretation of imaging, and operative management. To this end, the review focuses on obstructive hypertrophic cardiomyopathy and then broadens to discuss other pathologies causing LVOT obstruction, with important similarities and differences in their management. These other pathologies share some similar presentations and operative techniques, and at times can be confused with hypertrophic cardiomyopathy, but also have important distinctions of which the surgeon should be aware.

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The role of Ross procedure in the management of congenital heart defects

Orvosi Hetilap ◽

10.1556/oh.2013.29544 ◽

2013 ◽

Vol 154 (6) ◽

pp. 219-224

Author(s):

István Hartyánszky ◽

András Kollár ◽

Krisztina Kádár ◽

László Ablonczy ◽

Edit Novák ◽

...

Keyword(s):

Congenital Heart Defects ◽

Congenital Heart ◽

Left Ventricular Outflow Tract ◽

Heart Defects ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Ross Procedure ◽

Left Ventricular Outflow

Introduction: The surgical strategy to manage multilevel left ventricular outflow tract diseases is changing constantly, however, the Ross-procedure has remained a standard method for 45 years. Aim: The aim of the study was to analyze early and mid-term results of Ross-procedure in congenital heart defects (single surgeon’s results). Methods: From 2001 until 2011 a total of 63 patients (age, 28 days–21 years; mean: 10 years, weight 3.4–96 kg; mean, 8.8 kg) underwent Ross (n = 40), Ross–Konno (n = 17) or Ross–Konno-mitral (n = 6) procedures. Indication for Ross procedure was aortic regurgitation in 15 patients (associated with ventricular septum defect in 8 patients) and a predominant aortic stenosis in 25 patients. 17 patients with severe left ventricular outflow tract obstruction underwent Ross–Konno procedure. 6 patients with concomitant mitral valve disease (Shone syndrome, 3 patients; complete atrioventricular septal defect, 3 patients) were reconstructed by Ross–Konno-mitral valve procedure. Results: Among Ross patients there were one early (cerebral complication) and one late death (homograft endocarditis) with a mean follow-up time of 7.4±1.8 years. Because of an early autograft endocarditis a 3-year-old boy underwent homograft implantation and was treated successfully with Bentall-procedure 9 years later. One patient with autograft regurgitation is waiting for reoperation. Among Ross–Konno patients there was no early or late death, and none of the patients underwent reoperation. In Ross–Konno-mitral patients there was one early death (28-day-old boy) and during a mean follow-up time of 2.5±1 years, and no reintervention or reoperation was needed in 5 patients. Conclusions: The results indicate a good outcome of Ross-, Ross–Konno-, Ross–Konno-mitral procedures in patients with congenital heart defects when surgery is performed by a highly experienced heart surgeon. In newborns, infants and small children Ross- and Ross–Konno procedures are the only methods for managing left ventricular outflow tract diseases. Concomitant severe mitral disease adds a high level of technical complexity to the Ross–Konno/mitral procedure, but it should be balanced against alternative strategies (eg. single ventricle palliation or transplantation). Orv. Hetil., 2013, 154, 219–224.

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