title: Aortic valve replacement with anterior and posterior enlargement of small aortic annulus is comparable to surgery with normal annulus.
abstract: OBJECTIVE
  To compare results of aortic valve replacement in patients with normal annulus and in those undergoing anterior and posterior enlargement of a small annulus to implant a larger prosthesis.
  
  
  METHODS
  The study included 22 patients with enlargement of a small aortic annulus and 23 with a normal aortic annulus, with similar demographic characteristics and selected from a large surgical population. For normal annulus, simple valve replacement was performed. For annular enlargement, the posterior approach required incision in the mid portion of the non-coronary sinus, up to the anterior mitral leaflet; anterior enlargement was achieved by an incision between the left and right coronary ostium, extended to the ventricular septum for 2 cm. The aorta was reconstructed with bovine pericardium patches. The results analyzed included diameter of aortic annulus at surgery, clinical evolution (2 to 11 years of follow-up), left outflow tract obstruction and left ventricular mass (by Doppler echocardiography).
  
  
  RESULTS
  Enlargement increased the aortic annulus from 18.3 +/- 2.2 mm to 24.8 +/- 2.0 mm (p < 0.001), a value similar to aortic annulus considered normal: 24.9 +/- 1.5 mm (NS). For annular enlargement, the peak systolic gradient at the prosthesis decreased from 83.6 +/- 22.3 mmHg (preoperative) to 26.7 +/- 11.4 mmHg (p < 0.01) at the last evaluation. For normal annulus, a reduction from 68.2 +/- 28.7 mmHg to 32.8 +/- 16.2 mmHg occurred (p < 0.001) (final values similar between groups; NS). Left ventricular mass at the last evaluation was 147.2 +/- 45.9 for patients with enlargement and 148.1 +/- 70.4 for those with normal annulus.
  
  
  CONCLUSIONS
  Anterior and posterior aortic annulus enlargement enabled increases in annular diameter and valve prosthesis size, providing clinical and echocardiographic results similar to patients with valve replacement in a normal annulus.
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Brasil. santana.pesquisa@cardiologia.org.br
authors.forename: João Ricardo M
authors.initials: JR
authors.lastname: Sant'anna
authors.forename: Felipe W
authors.initials: FW
authors.lastname: de Bacco
authors.forename: Roberto T
authors.initials: RT
authors.lastname: Santánna
authors.forename: Renato A K
authors.initials: RA
authors.lastname: Kalil
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Prates
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Nesralla
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000033:anatomy & histology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male