A 19 mm Carpentier-Edwards Perimount Magna bioprosthesis can be successfully implanted in an elderly patient with a small aortic annulus, avoiding the need for aortic annular enlargement.
Supports feasibility of 19-mm bioprosthesis implantation without annular enlargement in select cases; leaves open questions on durability and generalizability.
An 82-year-old female was admitted to our hospital in December 2006 due to dyspnea resulting from cardiac failure accompanied by severe aortic stenosis and pulmonary hypertension. She recovered after medical treatment,but she was admitted again on May 7,2008 because of exacerbated dyspnea.Echocardiographic examination revealed aortic stenosis with a peak pressure gradient (PG)of 63 mmHg and severe tricuspidal regurgitation(TR).Cardiac catheterization showed an aortic valve area of 0.52 cm .On June 6,2008 she underwent aortic valve replacement (AVR) and tricuspid annuloplasty according to Kay’s method. Although a sizer for a Carpentier-Edwards standard prosthesis of 19 mm could not be inserted,another for a Carpentier-Edwards Perimount Magna prosthesis of 19 mm was inserted,and AVR was accomplished with this bioprosthesis while avoiding aortic annular enlargement. The patient recovered uneventfully and was discharged on the twelfth-postoperative-day.The results of postoperative echocardiography were ejection fraction 61%,mean PG 14 mmHg and,mild TR.
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Tsukioka et al. (2009) studied this question.
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