The Combined Konno-Nicks Procedure for Severely Stenotic Aortic Root and Left Ventricular Outflow Tract

BACKGROUND: Patients with a small aortic root and subvalvular stenosis are at risk of prosthesis-patient mismatch, making annular and left ventricular outflow tract (LVOT) enlargement essential. CASE SUMMARY: We herein report the case of a 41-year-old woman with prosthetic valve dysfunction and severe LVOT obstruction due to pannus formation in whom a 12-mm sizer could not be passed. Redo aortic valve replacement with the combined Konno-Nicks procedure successfully enlarged the annulus and LVOT, enabling the implantation of a 4-size larger prosthesis based on intraoperative sizer measurements. Postoperative echocardiography and computed tomography confirmed effective valve enlargement and preserved valve function. DISCUSSION: Combined anterior-posterior enlargement can be valuable for redo aortic valve replacement in patients with a small annulus and subvalvular stenosis to prevent prosthesis-patient mismatch. TAKE-HOME MESSAGE: The combined Konno-Nicks procedure can effectively relieve prosthetic valve dysfunction with severe subvalvular stenosis by enabling larger prosthesis implantation.