Hi Alchemist ! I’m not sure, but from my own research, I think they can get an idea before surgery of the size of the annulus (native “valve ring”) from CT angiogram or maybe transoesophageal echo - but I can’t say for sure. The implication is certainly that until the surgeon is in there they can’t know for sure what size they’ll use which is why they have the range of sizes of valve available. But they definitely can’t put in a bigger valve than the space available, because the tissue in the heart there is very fibrous, except by root enlargement which makes surgery take longer and carries some risk apparently. And there’s root replacement which carries more risk. Though both those carry less risk first surgery time round as there’s no scar tissue. Supra annular seems a good bet - I don’t know why that wasn’t done with me because the Magna Ease valve can be implanted in the supra annular position. And a stentless valve or mechanical valve gives a bigger orifice area. The other thing, like Neil Roberts said, is that there is some controversy regarding how much of a negative effect patient prosthesis mismatch actually has on the patient - here, and apologies to our American friends, he told me most of the studies had been done on "fat Americans" rather than “slim Europeans”, and the bigger the BMI of the patient the more effect patient prosthesis has - he was a very plain speaking guy which I like. I have read though, and again it will be controversial, that the more active the patient the more effect patient prosthesis mismatch has.
I wish I’d known all these things prior to surgery. I thought I was a pretty well informed patient having been on forum for some time before surgery and having read up a bit, but nowhere had I read anything about how the surgeons actually decide on how to give the best amount of valve orifice area to the patient if the patient has a small annulus. I’d never come across information about "small annulus”.
I’m not at all petite, Alchemist. Although I’m lean and my BMI is low I’m definitely not petite - I’m average height, I’ve got big feet, big legs, big shoulders, but I’ve got a bit of a depressed sternum which means there isn’t much space in there so my heart is small. I don’t think they thought of that prior to surgery. The same when I had my son - me being exactly average height with big feet no one realised that my pelvis is too small - I had to have an emergency cesarean at the last minute because my son was stuck - x-ray subsequently showed my pelvis is too small to ever have given birth normally but no one could have guessed (unless they’d x-rayed me).
It really is a relief to have found such a good surgeon - one who I can contact even by email directly. I read his reviews on ‘I want Great Care’ with a pinch of salt but now I can see that they are an accurate reflection of the man. I wish he’d been my surgeon as I’m sure many things would have turned out very differently when it came to my care.
Bon courage à toi !
