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. Author manuscript; available in PMC: 2022 Aug 1.
Published in final edited form as: Ann Thorac Surg. 2021 Mar 6;112(2):e139–e141. doi: 10.1016/j.athoracsur.2021.01.072

FIGURE 1.

FIGURE 1

(A) The left coronary cusp of Evolut valve was fractured (white arrow), resulting in severe aortic insufficiency. Because of small bioprostheses (23-mm Magna Ease and 23-mm Evolut valve as valve-in-valve), peak gradient across valves was 61 mm Hg and mean gradient was 33 mm Hg. (B) After removal of Evolut and Magna Ease valves and debridement of pannus and pledgets, aortic annulus was sized as 21 mm. (C) After aortomitral curtain was incised with Y incision, root was open by 3 cm from nadir of left coronary cusp to nadir of noncoronary cusp. (D) Rectangular patch was sewn to mitral annulus (white arrow) at bottom and aortic annulus (white stars) on both sides, enlarging the root. (E) A 27-mm Regent mechanical valve was chosen based on 27-mm Magna Ease valve sizer touching the three nadirs of three aortic cusps. The 27-mm Regent mechanical valve was placed in the enlarged aortic root and the position was marked on the Dacron patch to guide placement of valve sutures. (F) Mark on patch was lower than divided left-noncommissural post.