Modified Konno Procedure

In some patients, the left ventricular outflow tract is narrow and local tissue resection alone is inadequate to relieve the obstruction. A modified Konno procedure can be used in this diverse group of patients, which includes tunnel-like stenosis, stenosis in patients after total repair of complete atrio-ventricular (AV) canal, and some cases of hypertrophic cardiomyopathy. The geometry of the outflow tract is altered by full thickness resection of the ventricular septum working through a right ventriculotomy and an aortotomy. The left ventricular outflow tract is further augmented by ventricular septal defect (VSD) patch closure, placing the patch on the right ventricular surface of the septum. If that patch encroaches on the right ventricular outflow tract, an additional patch can be placed in the ventriculotomy. When the right ventricular outflow tract is not compromised by the intracardiac patch, the repair can be performed working through an aortotomy and an adjacent right atriotorny.

mitral valve chords

Modified Konno

papillary muscie excision caud papillary muscie excision mitral valve chords caud

Modified Konno

ventriculotomy ventricular septum

Figure 14-23. A ventriculotomy is made in the region of the right ventricular outflow tract.

Modified Konno

right ventricle outflow tract aortic valve

Figure 14-22. The child has been placed on cardiopulmonary bypass and the proximal ascending aorta opened. A normal aortic valve is identified and severe long segment subaortic stenosis seen.

right ventricle outflow tract ventriculotomy aortic valve caud

Figure 14-22. The child has been placed on cardiopulmonary bypass and the proximal ascending aorta opened. A normal aortic valve is identified and severe long segment subaortic stenosis seen.

ventricular septum

Figure 14-23. A ventriculotomy is made in the region of the right ventricular outflow tract.

aortotomy aortotomy

Modified Konno Procedure

lip of right angle clamp in VSD

Figure 14-24. An oblique incision is made in the ventricular septum starting immediately below the aortic valve and extending caudad toward the patient's left side (starting at or to the left of corpora arantii of the right coronary cusp to avoid the His' bundle). To identify this region, a right-angle clamp is passed through the aortic valve to protrude in the region of the septum to be incised.

lip of right angle clamp in VSD

Figure 14-24. An oblique incision is made in the ventricular septum starting immediately below the aortic valve and extending caudad toward the patient's left side (starting at or to the left of corpora arantii of the right coronary cusp to avoid the His' bundle). To identify this region, a right-angle clamp is passed through the aortic valve to protrude in the region of the septum to be incised.

Modified Konno

iatrogenic VSD

Figure 14-25. The large ventriculotomy is seen and through this region obstructing tissue in the left ventricle can be excised. If ventricular septal tissue is to be removed, this should be toward the patient's left in order to avoid the region of the bundle of His'.

iatrogenic VSD

Figure 14-25. The large ventriculotomy is seen and through this region obstructing tissue in the left ventricle can be excised. If ventricular septal tissue is to be removed, this should be toward the patient's left in order to avoid the region of the bundle of His'.

Konno Procedure

caud

Figure 14-26. Multiple felted mattress sutures are placed around the right ventricular surface of the VSD.

caud

Figure 14-26. Multiple felted mattress sutures are placed around the right ventricular surface of the VSD.

Dacron Patch Closure For Vsd

Figure 14-27. A Dacron® patch is used to close the VSD positioning the patch on the right ventricular surface of the septum.

caud

Figure 14-27. A Dacron® patch is used to close the VSD positioning the patch on the right ventricular surface of the septum.

Figure 14-28. The right ventriculotomy is closed with a tissue patch to enlarge the right ventricular tract; the aortotomy has been closed.

Konno Procedure

Figure 14-28. The right ventriculotomy is closed with a tissue patch to enlarge the right ventricular tract; the aortotomy has been closed.

outflow tract patch

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