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This video documents the investigation and treatment of a male patient who was referred with severe aortic valve stenosis. He was initially referred for consideration of transcatheter aortic valve replacement (TAVR). However, when the interventional cardiologist analyzed the aortic valve using 3mensio software, which is one of the most common ways to assess patients prior to TAVR, he discovered that the leaflets were, in fact, normal. The issue was severe subvalvular aortic stenosis with a lumen diameter of only 12 mm below a relatively normal aortic valve, although it did have regurgitation. In this video, the cardiologist instructively presented his analysis, showing all the steps of valve assessment and highlighting what was unusual in this case.
The operation began, and interestingly, this patient had previously undergone a sternotomy. The reason for this procedure was unknown and had occurred many decades prior. After reopening the sternum, Dr. Vince Gaudiani concluded that at some point, a surgeon had performed an open and close procedure, perhaps expecting pulmonary valve stenosis. However, upon opening the chest and discovering that this was not present, they simply closed the chest, as there were no sutures at all in the heart.
During the procedure, the aortic valve leaflets were resected revealing severe subvalvular stenosis beneath the aortic valve. This was resected in a similar fashion to a septal myectomy. Then, a Manougian left ventricular outflow tract enlargement was performed with a Dacron patch, and a 28 mm stented porcine tissue valve was implanted.
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