Aortoventriculoplasty for correction of patient-prosthesis mismatch examples

Patient-prosthesis mismatch is often considered as an important cause of adverse outcome following aortic valve replacement. A small annulus represents a challenge for the surgeon; yet can be best managed at the initial operation using relatively simple techniques, as later-on correction is often far more challenging. Corrective reoperations necessitate drastic root enlargement, along with the relief of subvalvular muscular obstruction.

The Konno-type aorto-ventriculoplasty is preferred in the present case series in order to achieve a radical aortic annulus enlargement in difficult reoperation settings and to address the accompanying subvalvular obstruction due to muscular hypertrophy simultaneously as well, with the septal patch included in the technique.

This approach provides satisfactory relief of the obstruction at both valvular and subvalvular level and the benefits are immediately evident, as symptoms abruptly end in all cases.

Long-term outcome is also excellent in both clinical and haemodynamic terms, as reflected by the significant left ventricle mass regression, absence of symptoms and improved quality of life.