[Aortic Valve Reoperation in Small Aortic Annulus].

Pediatric patients with narrow aortic valve annulus are often forced to undergo repeated aortic valve surgery, and it is not uncommon to plan a treatment strategy from the beginning with the assumption of reoperation or staged surgery. This article describes the anatomical structure of the aorto-mitral curtain and presents an example case of the Yamaguchi method, a relatively infrequently performed aortic valve procedure, in anticipation of aortic annular enlargement as a third reoperation in a 15-year-old boy with critical aortic valve stenosis. In the Nicks procedure, the incision beyond the posterior annulus is limited to the fibrous tissue of the aorto-mitral curtain;in the Manouguian procedure on the other hand, the incision is extended beyond this point to the anterior leaflet of the mitral valve. In the Yamaguchi procedure, the Konno incision at the anterior annulus near the right-left commissure is added to the standard Nicks incision for posterior annular enlargement, and thus the narrow annulus is enlarged in two places using two separate patches. However, the anterior incision cannot be very deep because the area immediately below the anterior annulus is nearly muscular tissue. Usually the annulus is enlarged with four posterior pledgets and additional two anterior pledgets.