%0 Journal Article
%T Left Ventricular Outflow Tract Obstruction after Ross-Konno Operation
%A Cenap Zeybek
%A Mustafa Kemal Avsar
%A Ozg¨¹r Yildirim
%A Mehmet Salih Bilal
%J Open Access Library Journal
%V 4
%N 6
%P 1-5
%@ 2333-9721
%D 2017
%I Open Access Library
%R 10.4236/oalib.1103644
%X
INTRODUCTION: SAM (systolic anterior motion) is
defined as the dynamic motion of the anterior mitral valve leaflet to the left
ventricular outflow tract (LVOT) during systole. In this study, we present a
case which we encountered with significant left ventricular outflow tract
obstruction (LVOTO) related to SAM and developed after Ross-Konno operation. METHOD:
A 4-month, 6.2 kg girl underwent balloon valvuloplasty due to bicuspid aortic
stenosis when she was one-month. Ross-Konno operation was performed on the patient due to residual aortic stenosis
(peak gradient of 140 mm Hg) and severe aortic regurgitation. Intraoperative
echocardiography (ECHO)
showed a peak gradient of 25 mmHg between the LV-Aorta. RESULTS: In the ICU at
postoperative 3. hour, when tachycardia began with the patient¡¯s hemodynamic
deterioration, SAM in ECHO and concomitant LVOTO (Peak grad: 140 mmHg) and 2nd
degree MY was identified. Pulmonary edema was observed along with a decrease in
oxygen saturation. The treatment initiated for removing the patient from hyperdynamic
state and reducing the volume deficit. Sedation and analgesia were increased.
The low-dose dobutamine was stopped. Tachycardia was attempted to take control
with beta-blockers. The same treatment was continued on day 2, but the
frequency of patient¡¯s tachycardia has not been reduced despite high doses of
beta blockers. Heart rate was controlled by Amiodarone. On day 4, mitral
regurgitation was slightly decreased while the LV-Aorta gradient was measured
between 50-60 mmHg. On day 5, SAM has
diminished greatly (20 mmHg). The patient was extubated 6th day and was
discharged on the 12th day without any problem. One year after, LVOT gradient
was not detected in the ECHO. DISCUSSION: In adult patients, although a variety
of surgical procedures for the removal of SAM had been reported, no experience
in infants exists in the literature on these techniques. Despite intensive
medical treatment, it may take longer than expected. We think that also the
decline of existing preoperative LV hypertrophy in this period contributes.
%K Systolic Anterior Motion Of Mitral Valve
%K Ross-Conno Operatio
%K Left Ventricular Outflow Tract Obstruction
%U http://www.oalib.com/paper/5285893