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.