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.
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Published online: December 06, 2013
Accepted: October 31, 2013
Received in revised form: October 25, 2013
Received: September 23, 2013
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.