Discussion:
Diffuse subaortic stenosis is difficult to treat, and needs extensive resection to effectively relieve the obstruction. Anterior aortoventriculoplasty (Konno-Rastan procedure) has been shown to be the effective management of complex LVOTO especially in patients with small aortic annulus (1, 2). The most challenging step of the operation is the incision across the aortic annulus which should be performed with great caution to avoid any injury to the conduction system, the native pulmonary valve, and the right coronary ostium (3). In our patient who had dextrocardia, this issue was of great importance due to the mirror-image anatomy, which means that this incision should be to the right (instead of the left) of the right coronary ostium (6, 7). In a retrospective study, the overall 30-day mortality was 11.5%, with significant improvement in the PG across the left ventricular outflow tract (6). To the best of our knowledge this is the first and only published case of Konno-Rastan operation in a patient with dextrocardia.