CHSS - Repair Of Complex Recurrent Left Ventricular Outflow Tract Obstruction After Atrioventricular Septal Defect Repair

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Repair Of Complex Recurrent Left Ventricular Outflow Tract Obstruction After Atrioventricular Septal Defect Repair - Trans Aortic And Left Atrial Approach
Manan H. Desai, Aybala Tongut, MD, Can Yerebakan, Sofia Hanaberg, Yves d'Udekem.
Children's National Medical Centre, Washington, DC, USA.

Objective(s): To demonstrate the technique of relief of complex recurrent subaortic obstruction in a case of atrioventricular septal defect
Methods: A 25-year-old known case of Trisomy 21 had undergone a two-patch repair of her atrioventricular septal defect in infancy. At the age of 8 years she required a transaortic repair of severe left ventricular outflow tract obstruction by a fibrous subaortic membrane. She now presented reduced effort tolerance due a LVOT gradient of 116 mmHg (peak) due to complex obstruction
Results: A re-entry sternotomy was performed safely and the aorta and left atrium were dissected. CPB was commenced and aorta was cross-clamped. Resection of fibrous subaortic obstruction and septal myectomy was performed via the aorta. The left atrium was opened and the superior bridging leaflet was detached. That gave us exposure to subvalvular fibrous tissue and tertiary chords. An additional myectomy was performed. The leaflet was augmented with a Cardiocel patch.Post-operative left ventricular outflow tract gradient reduced to 17 mmHg peak.
Conclusion: Two-chamber approach with a detachment of superior bridging leaflet on the left side and patch can provide adequate relief of complex left ventricular outflow tract obstruction several years after atrioventricular septal defect repair.

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