The Manouguian technique is a posterior aortic root enlargement technique used when the patient has a small aortic annulus and is undergoing aortic valve replacement. There are multiple aortic root enlargement techniques used to enlarge a small aortic root and outflow tract so that a larger aortic valve may be placed. The placement of a larger aortic valve allows the patient to avoid patient prosthesis mismatch (PPM) and structural valve deterioration. Implantation of a prosthetic valve of adequate size relative to the patient body surface area (BSA) can decrease the overall morbidity and mortality for the patient. The well-known postoperative complications associated with patient prosthetic mismatch have gained the attention of cardiac surgeons, so these techniques are used when a small aortic annulus with small outflow tracts is diagnosed. The Manouguian technique involves making an incision and extending it posteriorly through the commissure between the left coronary cusp and noncoronary cusp. The incision can then be carried onto the anterior mitral valve leaflet. There are multiple aortic root enlargement techniques, with the Nicks-Nunez procedure being another posterior aortic enlargement technique. The Nicks-Nunez technique involves making a vertical incision through the commissure. The incision is then carried between the left coronary cusp and noncoronary cusp all the way to the inner leaflet triangle, thus giving a larger aortic outflow tract. The Nicks-Nunez technique usually allows the placement of at least one valve size bigger. The Konno-Rastan procedure is an anterior aortic outflow tract enlargement technique. The Konno-Rastan technique involves making an incision 2 to 3 mm to the right of the anterior aortic valve commissure with an incision of the infundibular septum. When making this incision, care must be taken to not damage the conduction system or the first septal branch of the left anterior descending coronary artery. The aortic outflow tract can then be sized for a larger aortic valve. The overall goal is to recognize small aortic roots so that the best decision can be made to treat the small aortic root with an enlargement technique to avoid the associated morbidities of patient prosthesis mismatch.
马努吉安技术是一种主动脉根部扩大技术，用于主动脉瓣环较小且正在接受主动脉瓣置换术的患者。有多种主动脉根部扩大技术用于扩大较小的主动脉根部和流出道，以便能够植入更大的主动脉瓣。植入更大的主动脉瓣可使患者避免人工瓣膜与患者不匹配（PPM）以及人工瓣膜结构退化。相对于患者体表面积（BSA）植入尺寸合适的人工瓣膜可降低患者的总体发病率和死亡率。与人工瓣膜与患者不匹配相关的众所周知的术后并发症已引起心脏外科医生的关注，因此当诊断出主动脉瓣环小且流出道小的情况时会使用这些技术。马努吉安技术包括做一个切口，并将其向后延伸穿过左冠状动脉瓣叶和无冠状动脉瓣叶之间的交界处。然后该切口可延伸至二尖瓣前叶。有多种主动脉根部扩大技术，尼克 - 努涅斯手术是另一种主动脉根部扩大技术。尼克 - 努涅斯技术包括通过交界处做一个垂直切口。然后将切口延伸至左冠状动脉瓣叶和无冠状动脉瓣叶之间，一直到内叶三角区，从而获得更大的主动脉流出道。尼克 - 努涅斯技术通常允许植入至少大一号的瓣膜。康诺 - 拉斯坦手术是一种主动脉流出道前方扩大技术。康诺 - 拉斯坦技术包括在主动脉瓣前交界处右侧2至3毫米处做一个切口，并切开漏斗间隔。进行此切口时，必须注意不要损伤传导系统或左前降支冠状动脉的第一间隔支。然后可以确定主动脉流出道的尺寸以植入更大的主动脉瓣。总体目标是识别出较小的主动脉根部，以便能够做出最佳决策，采用扩大技术治疗较小的主动脉根部，以避免人工瓣膜与患者不匹配的相关发病率。
