“Prosthesis-patient mismatch” following aortic valve replacement is reported to be an important predictor for poor outcome in terms of left ventricle mass regression and survival. Its incidence tends to increase with the current liberal use of small-size (19-21 mm) mechanical valve prostheses. A 23-year-old women presented with chest pain, respiratory insufficiency, worsened functional capacity to NYHA class III, and recurrent attacks of syncope within the past three months. She had undergone aortic valve replacement of five-year history, with a 19-mm mechanical prosthesis due to aortic valve insufficiency. Echocardiography showed a peak systolic gradient of 103 mmHg (mean 57 mmHg) across the prosthesis. The effective orifice area index was found to be 0.37. At surgery, the aortic annulus was enlarged with the Konno procedure and the stenotic prosthesis was replaced by a 23-mm bileaflet mechanical prosthesis. On control examinations in the second and sixth months of reoperation, the patient was asymptomatic, her functional capacity improved to NYHA class I, with normal hemodynamic performance. There was no residual gradient across the prosthesis. Although the Konno procedure is generally reserved for pediatric patients, the presented case is typical for its application in adult cardiac surgery, and its perfectly satisfactory results justify its use in such complicated cases.

Keywords : Aortic valve/surgery; heart valve prosthesis/adverse effects; hemodynamic processes; postoperative complications; prosthesis design; prosthesis fitting