Prosthetic aortic stenosis: a method to prevent its occurrence by measurement of aortic size from preoperative aortogram.

A cause of early death after aortic valve replacement with a caged-ball prosthesis is obstruction to left ventricular outflow because the prosthesis is too large for the aortic root. Of 68 patients dying within two months of aortic valve replacement, death in ten, each of whom had had intractable low cardiac output after operation, was attributed at necropsy to prosthetic aortic stenosis, despite the use of small sized (8A StarrEdwards) prostheses in seven of them. The diameters of the aorta at the sinotubular junction, determined from the preoperative cineangiograms, in the seven patients with prosthetic stenosis were < 30 mm in all. Poppet clearances, defined as the differences between poppet and aortic root diameters, ranged from 4 to 12