Aortic Annular Enlargement during Aortic Valve Replacement

Authors

  • Selman Dumani University Hospital Center ”Mother Theresa”, Tirana
  • Ermal Likaj University Hospital Center ”Mother Theresa”, Tirana
  • Laureta Dibra University Hospital Center ”Mother Theresa”, Tirana
  • Stavri Llazo University Hospital Center ”Mother Theresa”, Tirana
  • Ali Refatllari University Hospital Center ”Mother Theresa”, Tirana

DOI:

https://doi.org/10.3889/oamjms.2016.098

Keywords:

AAE-aortic annulus enlargement, Manouguian technique, PPM-patient - prosthesis mismatch, AVR-aortic valve replacement, iEOA-indexed effective orifice area

Abstract

In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery.

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References

Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision to the anterior mitral leaflet. J Thorac Cardiovasc Surg. 1979;78:402—12. PMid:470420

Rahimtoola SH. The problem of valve prosthesis—patient mismatch. Circulation. 1978;58:20—4. http://dx.doi.org/10.1161/01.CIR.58.1.20 PMid:348341

Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart. 2006;92:1022–1029. http://dx.doi.org/10.1136/hrt.2005.067363 PMid:16251232 PMCid:PMC1861088

Nu-ez L, Gil Aguado M, Pinto GA, Larrea JL. Enlargement of the Aortic Annulus by Resecting the Commissure Between the Left and Noncoronary Cusps. Tex Heart Inst J. 1983; 10(3): 301–303.

Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root: the problem of aortic valve replacement. Thorax. 1970;25:339—46. http://dx.doi.org/10.1136/thx.25.3.339 PMid:5452289 PMCid:PMC472719

Kinsley RH, Antunes MJ. Enlargement of the narrow aortic root and oblique insertion of a St. Jude prosthesis. Br Heart J. 1983;50:330—2. http://dx.doi.org/10.1136/hrt.50.4.330 PMid:6626394 PMCid:PMC481419

Coutinho GF, Correia PM, Paupe´rio G, De Oliveira F, Antunes MJ. Aortic root enlargement does not increase the surgical risk and short-term patient outcome? European Journal of Cardio-thoracic Surgery. 2011;40: 441—447. http://dx.doi.org/10.1016/j.ejcts.2010.11.064

Castro LJ, Arcidi MJ, Fisher AL, Gaudiani VA. Routine enlargement of the small aortic root: a preventive strategy to minimize mismatch. Ann Thorac Surg. 2002;74:31—6. http://dx.doi.org/10.1016/S0003-4975(02)03680-9

St. Rammos K, Ketikoglou DG, Koullias GJ, Tsomkopoulos SG, Rammos CK, Argyrakis NP. The Nicks–Nunez posterior enlargement in the small aortic annulus:immediate–intermediate results. Interactive CardioVascular and Thoracic Surgery. 2006; 5:749–754. http://dx.doi.org/10.1510/icvts.2006.136457 PMid:17670704

Srivastava DK, Sanki P, Bhattacharya S, Siddique JV. Strategy to avoid patient-prosthesis mismatch: aortic root enlargement. Asian Cardiovasc Thorac Ann. 2014;22(2):137-41. http://dx.doi.org/10.1177/0218492312469117 PMid:24585782

LaPar DJ, Ailawadi G, Bhamidipati CM, Stukenborg G, Crosby IK, Kern JA, Kron IL. Small Prosthesis Size in Aortic Valve Replacement Does Not Affect Mortality. Ann Thorac Surg. 2011;92:880-888. http://dx.doi.org/10.1016/j.athoracsur.2011.04.105 PMid:21871273 PMCid:PMC3260881

Dhareshwar J, Sundt TM 3rd, Dearani JA, Schaff HV, Cook DJ, Orszulak TA. Aortic root enlargement: what are the operative risks? J Thorac Cardiovasc Surg. 2007;134(4):916-24. http://dx.doi.org/10.1016/j.jtcvs.2007.01.097 PMid:17903507

Peterson MD, Borger MA, Feindel CM, David TE. Aortic Annular Enlargement During Aortic Valve Replacement: Improving Results with Time. Ann Thorac Surg. 2007;83:2044 –9. http://dx.doi.org/10.1016/j.athoracsur.2007.01.059 PMid:17532393

Published

2016-09-02

How to Cite

1.
Dumani S, Likaj E, Dibra L, Llazo S, Refatllari A. Aortic Annular Enlargement during Aortic Valve Replacement. Open Access Maced J Med Sci [Internet]. 2016 Sep. 2 [cited 2021 Oct. 24];4(3):455-7. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2016.098

Issue

Section

C- Case Reports

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