Emile A. Bacha, MDa, Gary M. Satou, MDb, Adrian M

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Valve-sparing operation for balloon-induced aortic regurgitation in congenital aortic stenosis Emile A. Bacha, MDa, Gary M. Satou, MDb, Adrian M. Moran, MDb, David Zurakowski, PhDc, Gerald R. Marx, MDb, John F. Keane, MDb, Richard A. Jonas, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 122, Issue 1, Pages 162-168 (July 2001) DOI: 10.1067/mtc.2001.114639 Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Central incompetence caused by dilation of the sinuses of Valsalva is managed by resection of a wedge of one or more sinuses (top) followed by primary closure (bottom). The Journal of Thoracic and Cardiovascular Surgery 2001 122, 162-168DOI: (10.1067/mtc.2001.114639) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Typical AR induced by balloon dilation. There is a tear anteriorly in the region of the right coronary cusp. There is retraction of cusp tissue, prolapse of the rest of the cusp, and thickening of the free edges at the site of the tear. The valve is viewed from above (top) and below (bottom). The Journal of Thoracic and Cardiovascular Surgery 2001 122, 162-168DOI: (10.1067/mtc.2001.114639) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Typical autologous pericardial repair of balloon dilation injury. The patch not only fills the defect but also reconstructs the anterior commissure, thereby resuspending the prolapsed leaflet. Note that the patch is slightly redundant and overlaps the adjacent cusp. Views are from above (left) and below (right). The Journal of Thoracic and Cardiovascular Surgery 2001 122, 162-168DOI: (10.1067/mtc.2001.114639) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Kaplan-Meier estimates of freedom from aortic valve reintervention. Error bars indicate 70% CIs. Numbers of patients in the follow-up on whom the estimates were based are shown in parentheses. No patient required reintervention for late recurrence of AR. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 162-168DOI: (10.1067/mtc.2001.114639) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 Degree of AR at immediate and long-term follow-up for each individual patient (P <.001 for preoperative vs last follow-up degree of AR). post-op, Postoperative. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 162-168DOI: (10.1067/mtc.2001.114639) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 Changes in individual LVEDD z scores (see text for statistics). preop, Preoperative; post-op, potoperative. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 162-168DOI: (10.1067/mtc.2001.114639) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 7 Kaplan-Meier estimates of freedom from increased AR. Error bars indicate 70% CIs. Numbers of patients in the follow-up on whom the estimates were based are shown in parentheses. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 162-168DOI: (10.1067/mtc.2001.114639) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 8 Changes in degree of AS (P =.95; see text for definitions). The Journal of Thoracic and Cardiovascular Surgery 2001 122, 162-168DOI: (10.1067/mtc.2001.114639) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions