Surgical treatment for a complicated congenital aortic stenosis. The association of a three-level obstruction of the left ventricular outflow tract with mitral incompetence, coarctation of the aorta, and the Wolff-Parkinson-White syndrome.

We report a case of complex congenital aortic stenosis with obstruction at all three levels of the left ventricular outflow tract (subaortic, aortic, and supravalvular aortic stenoses) associated with a mitral malformation, coarctation of the aorta, and the Wolff-Parkinson-White syndrome. The subaortic stenosis was corrected by excision and myotomy, and the supravalvular stenosis by a widening prosthetic operation with a Dacron patch extending as far as the aortic ring, at which level a Björk-Shiley No. 17 aortic prosthesis was inserted. The mitral valve was replaced by a Lillehei-Kaster prosthesis. The coarctation of the aorta was not significant and was left alone. Permanent pacing was needed because of peroperative surgical section of the bundle of His. Reviews of the literature and the various techniques used to widen the left ventricular outflow tract are included.