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

BACKGROUND

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.

CASE SUMMARY: 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.

DISCUSSION: 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.

TAKE-HOME MESSAGES: 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.