title: Aortic valve replacement with concomitant annular enlargement for small aortic annulus of less than 19 mm.
abstract: Three female patients with aortic stenosis associated with a severely small annulus underwent aortic valve replacement. In intraoperative measurements, a 19-mm obtulator could not pass through the aortic annulus in each case. We therefore concluded that it would be difficult to implant an appropriate-sized prosthesis in a routine fashion, so we performed an annular enlargement in a modified Nicks procedure. By using a wide teardrop-shaped patch for enlargement and slightly tilting insertion of a prosthesis, a 21 mm bileaflet mechanical prosthesis could be inserted into the enlarged annulus. Despite being a simpler method than other enlarging procedures, a two- or three-sizes larger prosthesis than the native annulus can be inserted with relative ease. Thus, the use of a 19 mm mechanical prosthesis may be avoidable in most adult cases.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Cardiovascular and Respiratory Center, 1696 Itai Kounan-machi, Osato-gun, Saitama 360-0105, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Takakura
authors.forename: T
authors.initials: T
authors.lastname: Sasaki
authors.forename: K
authors.initials: K
authors.lastname: Hashimoto
authors.forename: T
authors.initials: T
authors.lastname: Hachiya
authors.forename: K
authors.initials: K
authors.lastname: Onoguchi
authors.forename: M
authors.initials: M
authors.lastname: Oshiumi
authors.forename: S
authors.initials: S
authors.lastname: Takeuchi
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design; D013536:Suture Techniques