A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring.

The smallest commercially available prosthetic valve has an external diameter of 17 mm. Therefore, prosthetic valve replacement has been unfeasible in cases in which the diameter of the aortic valve ring is smaller than this size. A new operative method was used on 2 patients with congenital aortic valve lesions associated with hypoplasia of the valve ring. The procedure consists of a longitudinal incision in the aortic septum placed in the midportion of the two coronary ostia, a vertical incision in the outflow tract of the right ventricle to join the septal incision, prosthetic aortic valve replacement, and patch reconstruction of the outflow tracts of both ventricles by means of two layers of a fusiform Dacron patch. A 23-year-old woman with congenital aortic stenosis associated with hypoplattic aortic valve ring underwent prosthetic placement of the aortic valve and is well 1 year after the operation. Our other patient, a 3-month-old infant with congenital aortic regurgitation, died on the first postoperative day because of postperfusion lung. However, her hemodynamic status had been good in the immediate postoperative period.