Use of the 21-mm Björk-Shiley Monostrut valve in patients with a narrow aortic root.
Technical considerations regarding the insertion of 21-mm Björk-Shiley Monostrut valves, particularly regarding decalcification of a calcified annulus with an ultrasonic surgical dissector, in patients with aortic stenosis and a narrow aortic root are described. Short-term follow-up (mean(s.d.) 37(10) months) is also presented. Ten adults whose body surface area ranged from 1.26 to 1.47 m2 underwent implantation of a 21-mm valve without outflow patch or annuloplasty. One operative death occurred; there were no other complications. The New York Heart Association functional class decreased from a mean of 3.2 before surgery to 1 in all cases. The mean(s.d.) end-diastolic volume decreased from 129(44) ml to 80(21) ml, and the end-systolic volume from 41(21) ml to 27(10) ml (P < 0.01). The mean(s.d.) maximum velocity, as measured by Doppler echocardiography in the aortic position, decreased from 4.35(0.55) m/s to 2.42(0.59) m/s (P < 0.01). This degree of improvement was not meaningfully different from that of the 23-mm valve. However, there was a negative correlation between the reduction in left ventricular mass and body surface area (r = -0.72, P < 0.03). It is concluded that the 21-mm Björk-Shiley Monostrut valve can be inserted using a modified technique in most patients with a narrow aortic root. This size valve is satisfactory when the patient's body surface area is < 1.45 m2.
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
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K
Hashimoto
K
K
Mashiko
M
M
Nakano
S
S
Horikoshi
H
H
Kurosawa
T
T
Arai
D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged