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Ann Thorac Surg 1997;63:261-263
© 1997 The Society of Thoracic Surgeons

How To Do It

Two-Directional Aortic Annular Enlargement for Aortic Valve Replacement in the Small Aortic Annulus

Masaki Otaki, MD, Hidetaka Oku, MD, Susumu Nakamoto, MD, Hitoshi Kitayama, MD, Masao Ueda, MD, Terufumi Matsumoto, MD

Department of Cardiac Surgery, Kinki University School of Medicine, Osaka-Sayama-shi, Osaka, Japan

Accepted for publication September 13, 1996.

We have encountered 3 patients with a small aortic annulus for whom the conventional posterior enlargement alone was not extensive enough to implant an artificial valve of acceptable size. Therefore, we performed two-directional enlargement, which is a combination of posterior and anterior enlargement. First, the posterior enlargement was done, and then an additional aortotomy was made anteriorly and extended to the ventricular septum. The aortic annulus was enlarged by 68% after the two-directional enlargement. At a follow-up of 31 months, the patients' functional status was New York Heart Association class I.




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