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J Thorac Cardiovasc Surg 2003;126:818-820
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

A new aortoventriculoplasty for prosthetic aortic valve replacement

Ulrik Hvass, MDa,*, Franck Baron, MDa, A. Elsebaey, MDa

a From the Hôpital Bichat AP-HP, Paris, France

Received for publication October 24, 2002; revisions received November 12, 2002; revisions received November 20, 2002; accepted for publication December 2, 2002.

* Address for reprints: Dr U. Hvass, AP-HP Hôpital Bichat, 46 rue Henri Huchard, Paris 75018, France
Ulrik.Hvass{at}bch.ap-hop-paris.fr

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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