Causes and management of aortic valve regurgitation after aortic valve reimplantation Christian Giebels, MD, Diana Aicher, MD, Takashi Kunihara, MD, PhD,

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Presentation transcript:

Causes and management of aortic valve regurgitation after aortic valve reimplantation Christian Giebels, MD, Diana Aicher, MD, Takashi Kunihara, MD, PhD, Svetlana Rodionycheva, MD, Wolfram Schmied, Dipl Psych, Hans-Joachim Schäfers, MD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 3, Pages 774-780 (March 2013) DOI: 10.1016/j.jtcvs.2012.03.016 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Intraoperative transesophageal echocardiogram after aortic root remodeling. Adequacy of cusp configuration determined by measurement of effective height. Dotted line indicates level of the basal ring or “annulus.” The effective height is the distance between the central free cusp margins and the annular level orthogonal to the latter. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 774-780DOI: (10.1016/j.jtcvs.2012.03.016) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Intraoperative photograph of excised aortic cusps from patient with Marfan syndrome 10 years after valve reimplantation (patient 7). In particular, left and right coronary cusps are retracted. LC, Left coronary; RC, right coronary; NC, noncoronary. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 774-780DOI: (10.1016/j.jtcvs.2012.03.016) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Preoperative transesophageal echocardiogram of 35-year-old patient 3 months after valve reimplantation (patient 13). The cusps, including the coaptation line, are below the level of the vascular graft, indicating extensive prolapse. B, Postoperative transesophageal echocardiogram of patient 13 after reoperative root remodeling. The configuration of the valve is normalized, although additional cusp plication was performed only on the left coronary cusp. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 774-780DOI: (10.1016/j.jtcvs.2012.03.016) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions