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Repair of Congenital Aortic Valve Disease

Repair of Congenital Aortic Valve Disease. Department of Thoracic and Cardiovascular Surgery Seoul National University Hospital Yong Jin Kim, M.D. Patient Profile ( I ). Male / 9 years History Heart murmur detected at birth (1992-02-13) 95-05-11 Lateral tunnel Fontan Op.

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Repair of Congenital Aortic Valve Disease

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  1. Repair of Congenital Aortic Valve Disease Department of Thoracic and Cardiovascular Surgery Seoul National University Hospital Yong Jin Kim, M.D.

  2. Patient Profile ( I ) • Male / 9 years • History • Heart murmur detected at birth (1992-02-13) • 95-05-11 Lateral tunnel Fontan Op. • 00-12-19 Coil embolization • RPA & RUPV arteriovenous collateral • Left IMA collateral to left lung

  3. Patient Profile ( II ) • Chief complaints • DOE (Functional Class II- III) • Systemic review • Clubbing, cyanosis • Physical examination • Gr II~III/VI systolic murmur at apex • Peripheral O2 saturation : 80% at room air • EKG • HR : 80~100 beats/min • NSR with occasional PVC

  4. Initial Diagnosis • {A, D, L} • RV type SV ( Rudimentary LV ) • SA (Common AV valve) • Bilateral SVC, IVC to hemiazygos( Left SVC ) • PS & PDA

  5. 0 • Age : 3yr • Bwt 13kg / Height 94cm / BSA 0.58m2 • Fenestrated Fontan Operation • Fenestration 5.5mm • Lateral tunneling with GoreTex patch • Bilateral BCPC • PDA division • MPA division

  6. Lateral Tunnel Fontan Op.

  7. Pre-op Chest X-ray ( 2001.4.10)

  8. Preoperative Diagnosis • Hepatic vein into pulmonary atrium • Adjacent to the coronary sinus & intrahepatic collateral formation • Atrioventricular valve regurgitation ; moderate • Aortic insufficiency ; moderate to severe • Aortic Root (Echocardiography) • Aortic annulus : 24 mm. • Sinus : 35~37 mm. • Sinotubular junction : 30~32 mm

  9. Pre-Op Cardiac Catheterization

  10. Operation (2001-04-16) • Extracorporeal circulation • CPB time : 159 min / ACC time : 88 min • Cannulation • Arterial cannular : Ascending aorta • Venous cannula : Into the lateral tunnel • Cardioplegics • Blood cardioplegics : Direct antegrade • 400cc/time × 3 times / Total Amount : 1200 cc

  11. Operative Technique ( I ) A B • A.Triangular resections of the dilated sinus wall • Excision varies with the redundancy of the sinus wall • & degree of reduction of the sinotubular junction • B. Reconstruction of the aortic root

  12. Operative Technique ( II ) Ascending aorta reduction plasty Subcommissural annuloplasty

  13. Operation (2001-04-16) • Hepatic vein ligation & clipping • Aortic root reconstruction Subcommissural annuloplasty, reduction of sinus & sinotubular junction by triangular resection (Valve sizer 21mm in reduced sinotubular junction) • Ascending aorta reduction plasty • Atrioventricular valve repair

  14. Post-Op Chest X-ray

  15. Postoperative EchoCG • Aortic valve regurgitation • Trivial • Atrioventricular valve regurgitation • Trivial • Atrioventricular valve stenosis • None • Ligated left hepatic vein • Good ventricular contraction • Good pulmonary venous inflow

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