Apico-aortic conduits in children with severe left ventricular outflow tract obstruction

Khanna, S K; Anstadt, Mark P.; Bhimji, Shabir; Bannan, Mary; Mawulawde, Kwabena; Zumbro, George L.; Moore, H. Victor

doi:10.1016/s0003-4975(01)03291-x

Cited by 21 publications

(9 citation statements)

References 10 publications

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“…Although the technique of AAVC has not gained popularity as surgical treatment for left ventricular outflow obstruction, it has been reported that AAVC reduces the LV-Ao pressure gradient, preserves left ventricular function, maintains normally distributed blood flow through the systemic and coronary circulation and improves quality of life [7,11,19].…”

Section: Discussionmentioning

confidence: 99%

An Experimental Study of Apico-Aortic Valved Conduit (AAVC) for Surgical Treatment of Aortic Stenosis in Dogs

Hirao

Inoue

Hoshi

et al. 2005

The Journal of Veterinary Medical Science

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ABSTRACT. A new valved conduit was developed using a canine aortic valve. The bioprosthetic valve was fixed with glutaraldehyde and epoxy compound (Denacol-EX313/810). A vascular graft composed of ultra-fine polyester fiber (10 mm in diameter, 200 mm in length) was used. Four dogs underwent apico-aortic valved conduit (AAVC) implantation and aortic banding (bypass group, BG), while another 4 dogs underwent aortic banding without AAVC implantation (control group, CG). Cardiac catheterization and angiocardiography were performed for assessment of hemodynamics 2 weeks and 6 months after surgery. Left ventricular systolic pressure, left ventricular enddiastolic pressure and the left ventricular-aortic pressure gradient differed significantly (P<0.01) between the BG and CG dogs. Left ventricular angiocardiography showed patency of the valved conduit in all the BG dogs. Echocardiography was performed before and 2, 4 and 6 months after surgery, and showed that while pressure overload caused concentric myocardial hypertrophy in the CG dogs, the left ventricle dilated eccentrically in the BG dogs. Furthermore, relief of left ventricular pressure overload by AAVC was maintained. KEY WORDS: aortic banding, aortic stenosis, apico-aortic valved conduit, bioprosthetic valve.J. Vet. Med. Sci. 67(4): 357-362, 2005 Aortic stenosis (AS) is one of the most common congenital cardiac malformations observed in dogs, and the most frequently encountered cardiac disease, especially in large breeds. Of the three forms of AS, supravalvular, valvular and subvalvular, subvalvular aortic stenosis (SAS) is the most common form reported in dogs [2,4]. The clinical pathophysiology of all forms of AS, owing to left ventricular outflow tract obstruction (LVOTO), is an increase in left ventricular pressure overload and a pressure gradient across the obstruction. These factors cause left ventricular concentric hypertrophy and myocardial ischemia. The clinical signs of AS vary with the severity of the obstruction. While dogs with mild AS are asymptomatic, dogs with moderate to severe AS may have exercise intolerance, syncope and even sudden cardiac death occurring without premonitory signs.Medical therapy for AS, namely beta-adrenergic blockades or calcium channel antagonists have been empirically prescribed to improve diastolic dysfunction of the left ventricle and decrease myocardial oxygen demand [2,12]. However, their value is unproven. Since medical therapy is not effective for severely affected dogs, and they may often die suddenly, surgical relief of the LVOTO is recommended.Surgical treatment of AS in dogs includes closed transventricular dilation [15,18] and percutaneous transluminal balloon dilation [8,13]. However, these techniques may be inadequate for specific forms of AS, surgical dilation of lesions may produce regurgitation or increase preexistent regurgitation, and may introduce the possibility of recurrence after temporary relief of the condition.Thus, open resection of the obstructing lesions during cardiopulmonary bypass (CPB)...

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Section: Discussionmentioning

confidence: 99%

An Experimental Study of Apico-Aortic Valved Conduit (AAVC) for Surgical Treatment of Aortic Stenosis in Dogs

Hirao

Inoue

Hoshi

et al. 2005

The Journal of Veterinary Medical Science

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“…The largest initial series reported intermediate results (Table 1), [10][11][12][13] but the complexity of the procedure limited widespread adoption. Apicoaortic conduits have been largely replaced by the Ross or Ross-Konno procedure in this population 1,14 ; only 1 case series of pediatric patients undergoing apicoaortic conduit insertion has been reported since the 1980s. 14 Currently, apicoaortic conduits are primarily limited to the treatment of severe, acquired aortic stenosis not amenable to conventional techniques.…”

Section: History and Current Statusmentioning

confidence: 99%

“…Apicoaortic conduits have been largely replaced by the Ross or Ross-Konno procedure in this population 1,14 ; only 1 case series of pediatric patients undergoing apicoaortic conduit insertion has been reported since the 1980s. 14 Currently, apicoaortic conduits are primarily limited to the treatment of severe, acquired aortic stenosis not amenable to conventional techniques. Transcutaneous aortic valve replacement, while very effective, 15 may be contraindicated in specific patients due to certain necessities of the surgical technique.…”

Section: History and Current Statusmentioning

confidence: 99%

Apicoaortic Conduits

Nance

Barraza

Henzler

et al. 2012

Journal of Thoracic Imaging

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Left ventricular apex to descending aorta conduits may be used as a last resort treatment of severe left ventricular outflow tract obstruction in cases in which alternative therapies are contraindicated. Although this technique is rarely used in current practice for congenital cases, its use in the elderly population is increasing, largely due to the expansion of this patient cohort and associated comorbidities precluding aortic valve replacement, the most common of which are a severely calcified "porcelain" aorta and/or previous coronary artery bypass grafts preventing aortic root manipulation. Diagnostic imaging is essential in the presurgical workup and subsequent follow-up of these patients, as complications of the procedure are potentially life threatening and are not rare. Several imaging modalities may be used, each with advantages and disadvantages. Both anatomic and functional assessments play a role in the comprehensive evaluation of both presurgical and postsurgical patients.

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“…156 Because of this, a number of procedures have been developed specifically to address long-segment stenosis. Some patients were treated by placing a conduit from the apex of the left ventricle to the aorta, [179][180][181][182][183][184] but the poor fate of the conduit, the impact of the surgery on the left ventricle, and the introduction of new surgical procedures have led to the near extinction of this technique. Some still use this approach for very selected patients, 184 and there is no doubt that this approach has afforded reasonable palliation.…”

Section: Evolutions In Therapeutic Modalitiesmentioning

confidence: 99%

Thoughts about fixed subaortic stenosis in man and dog

et al. 2005

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T HE LESION PRODUCING THE TYPICALLY FIXED form of obstruction within the left ventricular outflow tract seemingly changes and evolves after birth. As we will discuss, patients exhibiting this characteristic exhibit some aspects of both acquired and congenital cardiac malformations. In these respects, canine subaortic stenosis is remarkably similar, especially as seen in the Newfoundland breed. Indeed, there is now a considerable literature devoted to subaortic stenosis in several mammalian species, including the cow and swine as well as the dog. 1-11 As far as the dog is concerned, the Newfoundland is but one of a number of breeds found to harbour the fascinating lesion that obstructs the left ventricular outflow tract. The lesion has also been found in boxers, rottweilers, golden retrievers, German shepherds, German shorthaired pointers, and Bouviers de Flandres. 6-11 In this review, we will discuss in detail this fixed type of subaortic stenosis as seen in the setting of an intact ventricular septum, addressing the underlying pathology, the evolving methodologies of investigation, and the results after surgical intervention. When germane, we will make comparisons with knowledge of subaortic stenosis as seen in the dog, particularly the Newfoundland. We have excluded from discussion, however, those patients with an atrioventricular septal defect in the setting of common atrioventricular junction. The Newfoundland breed The Newfoundland dog figures importantly in discussions about subaortic stenosis. The Newfoundland breed, 12,13 during the 19th century, became a status symbol for European society. Indeed, at one time this particular dog was the most popular canine import to Great Britain. The dogs themselves became instantly recognizable after Sir Edwin Landseer painted one of their numbers in 1838. The portrait was entitled "A Distinguished Member of the Humane Society" (Fig. 1). The dog in question was called Paul Pry, Landseer was paid £80 for his efforts, and the painting was eventually dedicated to the Royal Humane Society. 14,15 Historical perspective of subaortic stenosis It is the report of Norman C. Chevers, published in 1842, which is likely the earliest description of subaortic stenosis in man. 16 More than 80 years later,

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Apico-aortic conduits in children with severe left ventricular outflow tract obstruction

Cited by 21 publications

References 10 publications

An Experimental Study of Apico-Aortic Valved Conduit (AAVC) for Surgical Treatment of Aortic Stenosis in Dogs

An Experimental Study of Apico-Aortic Valved Conduit (AAVC) for Surgical Treatment of Aortic Stenosis in Dogs

Apicoaortic Conduits

Thoughts about fixed subaortic stenosis in man and dog

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