A new aortoventriculoplasty for prosthetic aortic valve replacement
2003
Abstract Background Konno aortoventriculoplasty demands a complex double patch
reconstruction of left and right ventricular outflow tracts and is subjected to
a risk of permanent heart block. A modified technique was used to overcome these
difficulties. Patient and methods A 42-year-old woman with congenital aortic stenosis, a diminutive
aortic annulus, and severe subaortic muscular obstruction had undergone aortic
valve commissurotomy 24 years ago. At reoperation, a 19-mm St Jude Medical sizer
had a very tight fit after removal of the calcified aortic valve. To enlarge the
aortic annulus and septum, the pulmonary artery valve was first partly separated
from the right ventricle, exposing the interventricular septum. The aortic wall,
annulus, and septum were then split along the intercoronary commissure, a
location that clears the aortoventriculoplasty from the path of the major
conducting tissue. Once the septum was reconstructed with a Dacron patch, the
enlarged orifice accepted a St Jude Medical Flex 23. The mobilized pulmonary
artery valve was then sutured back to its original position, only changed by the
width of the septal Dacron patch. Result Discharge echocardiogram recorded a 7 mm Hg mean transprosthetic
gradient with a normally functioning pulmonary valve. The electrocardiogram
showed permanent sinus rhythm. Conclusions The described aortoventriculoplasty has several advantages,
including: a simple exposure obtained by partly separating the pulmonary artery
valve from the right ventricle; clear septal opening landmarks that avoid the
conducting tissue; easy reconstruction with a single septal patch; and an
anatomically restored right ventricular outflow tract.
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