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J Thorac Cardiovasc Surg 1994;108:788
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Aortic root enlargement by Manouguian's technique

Department of Cardiovascular Surgery
Southern Railway Headquarters Hospital
Perambur
Madras 600 023, India

To the Editor:

We read with interest the article by Kawachi, Tominaga, and Tokunaga ¹ titled "Eleven-Year Follow up Study of Aortic or Aortic-Mitral Anulus-Enlarging Procedure by Manouguian's Technique" and appreciate their results. However, our own experience is different from theirs.

Between June 1989 and September 1992, we have done aortic root enlargement by Manouguian's technique in 12 patients aged 20 to 51 years. One patient underwent aortic root enlargement as an emergency procedure for severe aortic regurgitation after balloon dilation of the aortic valve. In six patients, the anterior mitral leaflet was divided and a diamond-shaped Gelseal patch (gelatin-coated Dacron patch, Vascutek Inc., Inchinnan, Scotland) was sutured in the defect in the mitral leaflet. The edges of the Gelseal patch were buttressed by strips of pericardium as well. In the remaining six patients, a pericardial patch was used to bridge the defect in the mitral leaflet. Whenever the roof of the left atrium was opened, it was closed by a patch of pericardium.

A mechanical prosthetic valve, either St. Jude Medical (St. Jude Medical, Inc., St. Paul, Minn.) or Medtronic Hall (Medtronic, Inc., Minneapolis, Minn.), larger than the measured aortic root by either one or two sizes, was sewn into place with interrupted horizontal mattress sutures. None of the patients had any significant bleeding through the suture line. All the patients have been followed up for 6 months to 2 years and are doing well.

Unlike Kawachi, Tominaga, and Tokunaga, we used only mechanical valves. In addition, none of the patients had either mitral regurgitation or hemolysis. The patient-prosthesis mismatch or small-sized prosthesis can produce complications such as a significant gradient, left ventricular hypertrophy, thrombosis, and hemolysis. ² On the basis of our own experience and the report by Kawachi, Tominaga, and Tokunaga, we believe that aortic root enlargement can be done without much morbidity and the patient should be given the benefit of having a large prosthesis.

References

1. Kawachi Y, Tominaga R, Tokunaga K. Eleven-year follow-up study of aortic or aortic-mitral anulus-enlarging procedure by Manouguian's technique. J THORAC CARDIOVASC SURG 1992;104:1259-63.[Abstract]
   
2. Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation 1978;58:20-4.[Abstract/Free Full Text]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Arun K. Bhutani Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bhutani, A. K. Articles by Balakrishnan, K. R. Search for Related Content PubMed PubMed Citation Articles by Bhutani, A. K. Articles by Balakrishnan, K. R.