This is an image of a Brazilian patient before we proceeded | Figure 1

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This is an image of a Brazilian patient before we proceeded his #Coronary-artery-bypass-surgery very prominent cardiomegaly and a giant left atrium. Post operative: patient is doing well. Total of 3 grafts and a #Aortic-valve replacement. (Tissue).

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#Manouguian procedure for #aortic root enlargement. Patient required aortic valve replacement however it was not possible to fit a prosthetic valve large enough for the patient's body size. The aortic annulus was enlarged by extending the cut in the aorta down between the left & non-coronary cusps into the fibrous tissue of the subaortic curtain. A patch of bovine #pericardium was used to reconstruct the defect.

Heterogeneity is the rule with bicuspid aortic valves, so optimal surgical solutions vary by patient. Our experts share experience-based guidance for managing various presentations of bicuspid aortic valve and aortopathy:

If the valve is the primary indication for surgery (i.e., severe aortic stenosis and/or severe regurgitation):

1. Replace the aorta if >45 mm in diameter.
2. Replace the root too if it is >5 cm and AVR is being done. If the native valve is being retained, it needs to be stabilized, so the diameter threshold should be lowered to >45 mm.
3. Sometimes thresholds need to be lowered further, depending on the quality of tissue or for a small patient, such as an individual with Turner syndrome or other syndromic connective tissue disorder.

If the aorta is the primary indication for surgery: 4. Operate if the aorta is >5 cm in diameter or the cross-sectional area-to-height ratio is >10 cm2/m. 5. Consider sparing the valve if it looks healthy, but address the root if >45 mm. 6. Selectively lower thresholds. 7. In some cases, parts of the arch should be resected because this may be curative.