A Case of Aortic Valve Regurgitation with Subvalvular Aortic Stenosis and Extremely Small Annulus Treated with Left Ventricular Outflow Tract Myectomy with Y-incision Annular Enlargement and Aortic Valve Replacement

Abstract

We report on a case of left ventricular outflow tract myectomy with Y-incision annular enlargement and aortic valve replacement for aortic valve regurgitation associated with subvalvular aortic stenosis. Subvalvular aortic stenosis is recognized as congenital heart disease, with a few reports in adult cases. Left ventricular outflow obstruction in cases of subvalvular aortic stenosis can be relieved by either the Konno procedure or a modified Konno procedure. Additionally, there has been an increasing number of reports of valve annular enlargement using the Y-incision technique recently. Unlike the Manouguian and Konno procedure, the Y-incision technique allows for valve annular enlargement without cutting the left atrium, mitral valve, or right ventricular outflow tract. While the Konno procedure would typically be considered for this case, the Y-incision technique was selected for valve annular enlargement. This approach provided a clear view from the aortic valve annulus, enabling the excision of fibrous thickening and abnormal myocardium excision. This case resulted in a favorable postoperative course.