Heart, Lung and Circulation
Clinical Spotlight| Volume 23, ISSUE 3, e96-e99, March 2014

Aortoventriculoplasty for Correction of Patient-Prosthesis Mismatch Examples

Published:December 06, 2013DOI:


      Patient-prosthesis mismatch is often considered as an important cause of adverse outcome following aortic valve replacement. A small annulus represents a challenge for the surgeon; yet can be best managed at the initial operation using relatively simple techniques, as later-on correction is often far more challenging. Corrective reoperations necessitate drastic root enlargement, along with the relief of subvalvular muscular obstruction.

      Patients and methods

      The Konno-type aorto-ventriculoplasty is preferred in the present case series in order to achieve a radical aortic annulus enlargement in difficult reoperation settings and to address the accompanying subvalvular obstruction due to muscular hypertrophy simultaneously as well, with the septal patch included in the technique.


      This approach provides satisfactory relief of the obstruction at both valvular and subvalvular level and the benefits are immediately evident, as symptoms abruptly end in all cases.


      Long-term outcome is also excellent in both clinical and haemodynamic terms, as reflected by the significant left ventricle mass regression, absence of symptoms and improved quality of life.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pibarot P.
        • Dumesnil J.G.
        Prosthesis-patient mismatch: definition, clinical impact, and prevention.
        Heart. 2006; 92: 1022-1029
        • Rahimtoola S.H.
        The problem of valve prosthesis-patient mismatch.
        Circulation. 1978; 58: 20-24
        • Head S.J.
        • Mokhles M.M.
        • Osnabrugge R.L.
        • Pibarot P.
        • Mack M.J.
        • Takkenberg J.J.
        • et al.
        The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years.
        Eur Heart J. 2012; 33: 1518-1529
        • González-Juanatey J.R.
        • García-Acuña J.M.
        • Vega Fernandez M.
        • Amaro Cendón A.
        • Castelo Fuentes V.
        • García-Bengoechea J.B.
        • et al.
        Influence of the size of aortic valve prostheses on hemodynamics and change in left ventricular mass: implications for the surgical management of aortic stenosis.
        J Thorac Cardiovasc Surg. 1996; 112: 273-280
        • Rao V.
        • Jamieson W.R.
        • Ivanov J.
        • Armstrong S.
        • David T.E.
        Prosthesis-patient mismatch affects survival after aortic valve replacement.
        Circulation. 2000; 102: III-5-III-9
        • Pibarot P.
        • Dumesnil J.G.
        Live longer and better without prosthesis-patient mismatch.
        J Heart Valve Dis. 2009; 18: 245-247
        • Ruel M.
        • Rubens F.D.
        • Masters R.G.
        • Pipe A.L.
        • Bédard P.
        • Hendry P.J.
        • et al.
        Late incidence and predictors of persistent or recurrent heart failure in patients with aortic prosthetic valves.
        J Thorac Cardiovasc Surg. 2004; 27: 149-159
        • Milano A.D.
        • De Carlo M.
        • Mecozzi G.
        • D’Alfonso A.
        • Scioti G.
        • Nardi C.
        • et al.
        Clinical outcome in patients with 19-mm and 21-mm St. Jude aortic prostheses: comparison at long-term follow-up.
        Ann Thorac Surg. 2002; 73: 37-43
        • Konno S.
        • Imai Y.
        • Iida Y.
        • Nakajima M.
        • Tatsuno K.
        A new method for prosthetic valve replacement in congenital aortic stenosis with hypoplasia of the aortic ring.
        J Thorac Cardiovasc Surg. 1975; 70: 909-917
        • Mohty D.
        • Malouf J.F.
        • Girard S.E.
        • Schaff H.V.
        • Grill D.E.
        • Enriquez-Sarano M.E.
        • et al.
        Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic position.
        Circulation. 2006; 113: 420-426
        • Bleiziffer S.
        • Hettich I.
        • Hutter A.
        • Wagner A.
        • Deutsch M.A.
        • Piazza N.
        • et al.
        Incidence and impact of prosthesis-patient mismatch after transcatheter aortic valve implantation.
        J Heart Valve Dis. 2013; 22: 309-316
      1. Vural KM. Pitfalls in interpreting the patient-prosthesis mismatch outcome. Thorac Cardiovasc Surg,