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Ann Thorac Surg 2004;78:2216
© 2004 The Society of Thoracic Surgeons

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Correspondence

Reply

Center for Aortic Surgery, Marfan Syndrome and Connective Tissue Disorders Clinic, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, F25, 9500 Euclid Ave, Cleveland, OH 44195, USA

svenssl{at}ccf.org

To the Editor:

I appreciate the comments by Drs Cartier and Chaput concerning sizing for aortic root procedures. Whereas they use the presented table for remodeling the root, I think "downsizing" from their table is important for several reasons. First, the tables of allograft material probably "oversize" the annulus because after death, the root, which is a dynamic structure, relaxes and is artificially larger. Second, when the sutures are tied down, the diameter of the Hegar's dilator is not entirely achieved. Our routine transesophageal studies do not usually show the size to be that of the Hegar's dilator used. Furthermore, gradients are not more than 10 mm Hg at most. Third, after operation, and particularly with remodeling, the root tends to dilate. If the initial size is smaller, it accounts for the potential dilatation.

Thus, the size I [1] recommended are approximately one size (2 mm or so) smaller than those in the table of Drs Cartier and Chaput for equivalent body surface area and sex.

References

1. Svensson LG. Sizing for modified David's reimplantation procedure. Ann Thorac Surg. 2003;76:1751–1753[Abstract/Free Full Text]

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