Clinical experience with enlargement of the aortic anulus by extension of the aortic incision into the anterior mitral leaflet.

Implantation of a small-sized biological prosthesis into a hypoplastic aortic annulus causes significant resting gradients. To make insertion of a suitable biological valve possible, we recommend enlargement of the aortic annulus by extension of the aortic incision into the anterior mitral leaflet for approximately 2 cm. A woven Dacron patch is sutured into the V-shaped defect of the anterior mitral leaflet and the aortic ring. This procedure results in enlargement of the aortic circumference of approximately 20 mm. We have applied this technique in 13 patients with severe aortic valvular disease and a hypoplastic aortic annulus. In all patients a prosthesis with a diameter of at least 25 mm could be implanted. The maximal postoperative pressure gradient measured 18 mmHg. There was no early death related to this operative method. All survivors have excellent clinical results with no evidence of mitral regurgitation. This operation represents a practicable alternative method to left ventricular apico-aortic conduit implantation.