How to do itCoronary ostial enlargement to prevent stenosis after prosthetic aortic valve replacement
Section snippets
Technique
Out of more than 1800 aortic valve replacements performed at the Division of Cardiac Surgery of the University of Verona since 1992, three patients (< 0.2%), 2 male and 1 female, with a mean age of 66.6 years, operated upon for aortic stenosis, showed the abovementioned intraoperative complication.
In all cases, after the mechanical prosthesis was tied down in its final position, the coronary ostia (both in two cases; left main alone in one) appeared partially occluded by the device (Fig 1A).
Comment
Coronary ostia stenosis after aortic valve replacement determined by the device is a dreadful complication with a high mortality rate if left untreated 1, 2, 3, 4, 5, 6. Prompt recognition of the problem is mandatory and usually implies device removal and/or re-replacement with a smaller valve size with or without annular enlargement. This approach may be difficult, particularly in patients with small aortic root, and result in a very long ischemia time with possible subsequent myocardial
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