{"doi":"10.1186/s13019-025-03597-2","title":"Minimizing transaortic valve gradient in a young female with a large body habitus and small annulus: a case report","abstract":"BACKGROUND: Aortic valve replacement in the setting of a small aortic anulus and a large body habitus is challenging. A surgical aortic valve replacement (AVR) implanted circumferentially onto this native annulus will predictably result in patient-prosthesis mismatch (PPM). We discuss the decision making process for the management of this patient. CASE PRESENTATION: ). She had severe aortic stenosis in a small aortic annulus (diameter = 18 mm) and moderate-severe mitral stenosis. She underwent double mechanical valve replacement which included a Y-incision root enlargement to reduce obstruction to the left ventricular outflow tract (LVOT) by displacing the structural components of the On-X valve into the enlarged root away from the LVOT. CONCLUSIONS: A Y-incision root enlargement is an effective strategy to maximize use of the native LVOT to avoid PPM. In the setting of a mechanical AVR, this is expected to result in favorable long-term outcomes.","journal":"Journal of Cardiothoracic Surgery","year":2025,"id":578362,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9576,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":923184,"name":"Takahiro Kitsuka","orcid":null,"position":1,"is_corresponding":false},{"id":1369662,"name":"Ran Huo","orcid":"0000-0001-5066-986X","position":2,"is_corresponding":false},{"id":626256,"name":"Paul C. Tang","orcid":"0000-0003-4211-8587","position":3,"is_corresponding":false},{"id":1487977,"name":"Shuyang Lu","orcid":"0000-0002-3954-7623","position":0,"is_corresponding":true}],"reference_count":3,"raw_metadata":null,"created_at":"2026-07-19T02:58:20.638044Z","pmid":"41107916","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}