Extended septoplasty for left ventricular outflow tract obstruction after the intracardiac repair of double outlet right ventricle

A 14-year-old boy with a left ventrivular outflow tract obstruction (LVOTO) after the repair of double outlet right ventricle (DORV) at the age of 7 months was successfully treated with an extended septoplasty. A significant pressure gradient occurred between the left ventricle and the ascending aorta of 70 mmHg in spite of the previous surgery for LVOTO with muscle resection and the ventricular septal defect (VSD) patch enlargement at the age of 5. An extended septoplasty was performed including extensive resection of the conus muscle and the previously placed patch, long incision on the interventricular septum toward the apex, and reconstruction of the outflow tract using a Hemashield patch. The cathterization 10 months after the operation revealed an effective relief of LVOTO with left ventricle (LV) and aorta (Ao) pressure of 115 and 103 mmHg, respectively. An extended septoplasy is effective for the relief of LVOTO, but further follow-up is mandatory of both the left ventricular function and mitral valve function.