Aortic Valve Reconstruction With Leaflet Replacement and Sinotubular Junction Fixation: Early and Midterm Results Meong Gun Song, MD, Hyun Suk Yang,

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Aortic Valve Reconstruction With Leaflet Replacement and Sinotubular Junction Fixation: Early and Midterm Results Meong Gun Song, MD, Hyun Suk Yang, MD, Jong Bum Choi, MD, Yong In Kim, MD, Je Kyoun Shin, MD, Hyun Keun Chee, MD, Jun Seok Kim, MD, Dong Hyup Lee, MD The Annals of Thoracic Surgery Volume 97, Issue 4, Pages 1235-1241 (April 2014) DOI: 10.1016/j.athoracsur.2013.10.088 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) A 26-mm template, designed for tailoring bovine pericardium to form a 26-mm aortic pericardial leaflet. The length of the upper margin of the pericardial leaflet patch is the same as the diameter of the sinotubular junction, and the height of the patch is 70% of the diameter of the sinotubular junction. The template is larger than the real pericardial leaflet, because extra suture space (2.0 mm) is added to it. (B) The central 2/3 of the suture margin of the pericardial leaflet is plicated in a 1.5:1 ratio, and the lateral 1/3 of the pericardial leaflet is evenly sutured to the annulus. (ILT = interleaflet triangle.) The Annals of Thoracic Surgery 2014 97, 1235-1241DOI: (10.1016/j.athoracsur.2013.10.088) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig. 2 The sinotubular junction is fixed or reduced with inner and outer rings using 18 interrupted 4-0 polypropylene mattress sutures, and then the commissural coaptation suture (the last one) is made. The Annals of Thoracic Surgery 2014 97, 1235-1241DOI: (10.1016/j.athoracsur.2013.10.088) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Estimated freedom from redo aortic valve surgery of patients undergoing aortic valve reconstruction surgery. The Annals of Thoracic Surgery 2014 97, 1235-1241DOI: (10.1016/j.athoracsur.2013.10.088) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Kaplan-Meier analysis curve showing event-free survival of patients undergoing aortic valve reconstruction surgery. The Annals of Thoracic Surgery 2014 97, 1235-1241DOI: (10.1016/j.athoracsur.2013.10.088) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 In a short-axis view of the aortic valve (two-dimensional imaging [A, C] and color Doppler [B, D]), the competent valve closure at diastole (A, B) and the full valve opening at systole (C, D) of three reconstructed pericardial leaflets are demonstrated. The Annals of Thoracic Surgery 2014 97, 1235-1241DOI: (10.1016/j.athoracsur.2013.10.088) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Box-whisker plots for the comparison of mean preoperative left ventricular mass index (before surgery) versus mean postoperative left ventricular mass index (last follow-up). The left ventricular mass index, an expression of left ventricular hypertrophy, showed 19.6% regression on echocardiography during the follow-up period of 23.7 ± 16.4 months. The Annals of Thoracic Surgery 2014 97, 1235-1241DOI: (10.1016/j.athoracsur.2013.10.088) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions