Basal cusp enlargement for repair of aortic valve insufficiency

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Basal cusp enlargement for repair of aortic valve insufficiency Paul P. Urbanski, MD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 1, Pages 98-102 (January 2010) DOI: 10.1016/j.jtcvs.2009.03.058 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Intraoperative photographs showing basal cusp enlargement with pericardial patch in patients operated on using single patch technique (A through C) and reimplantation technique (D). A, Incision at base of cusp; B, pericardial patch sewn into cusp; C, aortic valve view after completion of cusp enlargement; D, cusp enlargement before reimplantation of valve into tube. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 98-102DOI: (10.1016/j.jtcvs.2009.03.058) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Schematic illustration of aortic root showing restoration of valve coaptation by narrowing subcommissural triangle (left) or increasing sinus depth withal cusp enlargement (right). The Journal of Thoracic and Cardiovascular Surgery 2010 139, 98-102DOI: (10.1016/j.jtcvs.2009.03.058) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Operative photograph (A) and preoperative transesophageal echocardiogram (B) showing aortic aneurysm with moderate dilatation of right coronary sinus of Valsalva and restriction of noncoronary cusp. C, Operative photograph showing good coaptation of all cusps after incision at base of restricted leaflet and its centripetal movement. D, Postoperative transesophageal echocardiogram showing excellent coaptation area with length of 10 mm after basal enlargement of noncoronary cusp with pericardial patch, repair of right coronary sinus of Valsalva with single-patch technique, and supracoronary ascending aorta replacement. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 98-102DOI: (10.1016/j.jtcvs.2009.03.058) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions