Opening and closing characteristics of the aortic valve after valve-sparing procedures using a new aortic root conduit Ruggero De Paulis, MD, Giovanni.

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Presentation transcript:

Opening and closing characteristics of the aortic valve after valve-sparing procedures using a new aortic root conduit Ruggero De Paulis, MD, Giovanni Maria De Matteis, MD, Paolo Nardi, MD, Raffaele Scaffa, MD, Maria Michaela Buratta, MD, Luigi Chiariello, MD The Annals of Thoracic Surgery Volume 72, Issue 2, Pages 487-494 (August 2001) DOI: 10.1016/S0003-4975(01)02747-3

Fig 1 Graft drawing (left) and photograph (right) of the new aortic root conduit. The skirted section of the graft has a height equal to the given graft diameter and has a 25% distensibility in the horizontal plane (bore size × 1.25). The collar is cut out when performing a remodeling type of valve-sparing procedure, is trimmed to a minimum in case of a reimplantation procedure, or is maintained for prosthetic valve attachment in the case of a Bentall procedure. The Annals of Thoracic Surgery 2001 72, 487-494DOI: (10.1016/S0003-4975(01)02747-3)

Fig 2 Schematic drawings of the remodeling type of valve-sparing procedure using the standard (left) and the new Dacron conduit (right). In order to generate sinuses with the standard prosthesis the tongue-shaped extensions need to be very long; in particular the length of the tongue (A-B) should be longer than the height of the valve remnants (A1-B1). Conversely, with the new prosthesis, given its potential for circumferential expansion, the two distances can perfectly match. In this way there is less chance of suture bleeding and less risk of slightly distorting valve geometry. The Annals of Thoracic Surgery 2001 72, 487-494DOI: (10.1016/S0003-4975(01)02747-3)

Fig 3 Schematic drawing of an M-mode tracing describing the measured aortic valve opening and closing features. (a-b = rapid valve opening; b-c = slow systolic closure; c-d = rapid valve closing; RVOT = rapid valve opening time; RVCT = rapid valve closing time; ET = ejection time; D1 = maximal leaflet displacement; SCD = slow closing displacement; D2 = leaflet displacement before rapid valve closing.) The Annals of Thoracic Surgery 2001 72, 487-494DOI: (10.1016/S0003-4975(01)02747-3)

Fig 4 Close up of a transesophageal long axis view of the aortic root during diastole in a patient of group A (standard prosthesis, A) and in a patient of group B (new prosthesis, B). Note the differences in shape and dimensions of the sinuses between the two groups. (Ao = aorta; LV = left ventricle.) The Annals of Thoracic Surgery 2001 72, 487-494DOI: (10.1016/S0003-4975(01)02747-3)

Fig 5 Plot of the individual values for the percent change in radius at the level of the sinuses (PCR sinus) and for the slow closing displacement (SCD) in the three groups of patients. The Annals of Thoracic Surgery 2001 72, 487-494DOI: (10.1016/S0003-4975(01)02747-3)

Fig 6 Transesophageal actual M-mode picture of the aortic box in a patient of group A (standard prosthesis, left) and in a patient of group B (new prosthesis, right). The difference in the slow closing displacement (a–b = rapid valve opening; b–c = slow systolic closure; c–d = rapid valve closing) is markedly evident. The Annals of Thoracic Surgery 2001 72, 487-494DOI: (10.1016/S0003-4975(01)02747-3)