Alfred Kocher technique for prevention of patient-prosthesis mismatch in paediatric patients.
Peter Murin, Martin Winter, Paul Werner et al.
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Case in brief
A 7-year-old girl requiring aortic valve replacement had a functionally unicuspid aortic valve. Although the Ross procedure is generally favored in children, an intraoperative bicuspid pulmonary valve made durable autograft transplantation unsuitable. To accommodate a larger mechanical valve, surgeons enlarged the posterior aortic root with the Alfred Kocher technique: an inverted T-shaped incision in the non-coronary sinus was reconstructed with a tailored patch. This increased the annular diameter by 5 mm, allowing implantation of a 21 mm mechanical prosthesis (diameter = 24 mm) from a 19 mm annulus.
What made this case unusual
The bicuspid pulmonary valve was discovered unexpectedly during surgery and changed the planned autograft option. Posterior root enlargement with the Alfred Kocher technique provided an alternative to the more complex Konno incision and patch ventriculoplasty described for this setting.
Diagnostic / clinical pearl
In a child unsuitable for a Ross procedure, posterior aortic root enlargement using the Alfred Kocher technique can permit implantation of a larger mechanical prosthesis; assess pulmonary valve anatomy because an unexpected abnormality may affect autograft suitability.