Large Left Ventricular Aneurysm Caused by Aortic Stenosis and Exacerbated by Prosthesis-Patient Mismatch

Few reports have documented left apical ventricular aneurysm attributable solely to aortic valve stenosis, rapidly exacerbated by prosthesis-patient mismatch (PPM), and necessitating unconventional redo surgical strategies.

A 42-year-old woman with a 17-year cardiac disease history was admitted to our institution. In 2018, she received a 17-mm mechanical aortic valve. In 2024, the unconventional redo procedures comprised left-ventricular aneurysmoplasty, direct-visualization endocardial radiofrequency ablation, Y-incision aortic root enlargement, and aortic and mitral valve replacement.

During the initial operation, implantation of a 17-mm prosthesis created moderate PPM, deteriorating over time. Achieving a balance between avoiding PPM and the risk of iatrogenic mitral compromise is often challenging but clinically essential.

Isolated aortic valve stenosis gives rise to an apical ventricular aneurysm, and PPM accelerates its expansion. The complex redo surgery demands meticulous preoperative planning and tactical intraoperative decision-making.