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Background <p>Aortic valve replacement in the setting of a small aortic anulus and a large body habitus is challenging. A surgical aortic valve replacement (AVR) implanted circumferentially onto this native annulus will predictably result in patient-prosthesis mismatch (PPM). We discuss the decision making process for the management of this patient.</p> Case presentation <p>We report our management strategy for a younger patient (55 years old) with a very large body habitus (body mass index = 63.3&#xa0;kg/m<sup>2</sup>). She had severe aortic stenosis in a small aortic annulus (diameter = 18&#xa0;mm) and moderate-severe mitral stenosis. She underwent double mechanical valve replacement which included a Y-incision root enlargement to reduce obstruction to the left ventricular outflow tract (LVOT) by displacing the structural components of the On-X valve into the enlarged root away from the LVOT.</p> Conclusions <p>A Y-incision root enlargement is an effective strategy to maximize use of the native LVOT to avoid PPM. In the setting of a mechanical AVR, this is expected to result in favorable long-term outcomes.</p>

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Minimizing transaortic valve gradient in a young female with a large body habitus and small annulus: a case report

  • 期刊论文

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  • 发表日期：

    2025年10月17日

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  • Shuyang Lu,
  • Takahiro Kitsuka,
  • Ran Huo,
  • Paul C. Tang

摘要

Background

Aortic valve replacement in the setting of a small aortic anulus and a large body habitus is challenging. A surgical aortic valve replacement (AVR) implanted circumferentially onto this native annulus will predictably result in patient-prosthesis mismatch (PPM). We discuss the decision making process for the management of this patient.

Case presentation

We report our management strategy for a younger patient (55 years old) with a very large body habitus (body mass index = 63.3 kg/m2). She had severe aortic stenosis in a small aortic annulus (diameter = 18 mm) and moderate-severe mitral stenosis. She underwent double mechanical valve replacement which included a Y-incision root enlargement to reduce obstruction to the left ventricular outflow tract (LVOT) by displacing the structural components of the On-X valve into the enlarged root away from the LVOT.

Conclusions

A Y-incision root enlargement is an effective strategy to maximize use of the native LVOT to avoid PPM. In the setting of a mechanical AVR, this is expected to result in favorable long-term outcomes.