Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of valsalva, and ventricular septal defect Magdi.

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Presentation transcript:

Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of valsalva, and ventricular septal defect Magdi H. Yacoub, FRCS, Hasnat Khan, FRCS, George Stavri, FRCS, Elliott Shinebourne, FRCP, Rosemary Radley-Smith, FRCP The Journal of Thoracic and Cardiovascular Surgery Volume 113, Issue 2, Pages 253-261 (February 1997) DOI: 10.1016/S0022-5223(97)70321-0 Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 1 A section in the aortic root and RVOT illustrating the dilatation of the aortic sinus and the discontinuity between the aortic media (black line) and anulus of aortic valve (dotted area at the base of the cusp), the lack of support to the anulus and the sinus of Valsalva, the downward and outward displacement of the anulus with the right ventricle, and the lack of coaptation between the aortic cusps. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 The location of the VSD and the sagging aortic cusp as viewed from the left side through a transaortic approach. The position of the conducting tissue and the pledget-supported sutures used for the repair is also shown both before (A) and after (B) the sutures are tied. Note the elevation of the ventricular crest and base of the cusp produced by the sutures that plicate the sinus of Valsalva. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 2 The location of the VSD and the sagging aortic cusp as viewed from the left side through a transaortic approach. The position of the conducting tissue and the pledget-supported sutures used for the repair is also shown both before (A) and after (B) the sutures are tied. Note the elevation of the ventricular crest and base of the cusp produced by the sutures that plicate the sinus of Valsalva. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 3 Section in a normal human aortic root showing the continuity between the aortic media and anulus. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 4 Echocardiogram in the parasternal long-axis view after anatomic correction of the syndrome showing the plicated sinus, with closure of the VSD, elevation of the cusp, and restoration of competence of the aortic valve. RV, Right ventricle; LV, left ventricle; LA, left atrium; MV, mitral valve. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 5 RVOT obstruction produced by bulging of the dilated right coronary sinus of Valsalva and a degree of hypertrophy of the RVOT myocardium. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 Two-dimensional echocardiograms illustrating all the features of the syndrome. A, Parasternal long-axis view during ventricular systole showing dilatation of the right coronary sinus of Valsalva and prolapse of the aortic sinus, anulus, and cusp with the right ventricle. B, Parasternal long-axis view during diastole showing further prolapse of cusp/sinus and anulus with failure of coaptation of cusps. C, Apical four-chamber view showing the relation of the prolapsed sinus/cusp to the crest of the ventricular septum. LV, Left ventricle; RV, right ventricle; LA, left atrium; MV, mitral valve; LVOT, left ventricular outflow tract; LC, left coronary artery. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 Two-dimensional echocardiograms illustrating all the features of the syndrome. A, Parasternal long-axis view during ventricular systole showing dilatation of the right coronary sinus of Valsalva and prolapse of the aortic sinus, anulus, and cusp with the right ventricle. B, Parasternal long-axis view during diastole showing further prolapse of cusp/sinus and anulus with failure of coaptation of cusps. C, Apical four-chamber view showing the relation of the prolapsed sinus/cusp to the crest of the ventricular septum. LV, Left ventricle; RV, right ventricle; LA, left atrium; MV, mitral valve; LVOT, left ventricular outflow tract; LC, left coronary artery. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 6 Two-dimensional echocardiograms illustrating all the features of the syndrome. A, Parasternal long-axis view during ventricular systole showing dilatation of the right coronary sinus of Valsalva and prolapse of the aortic sinus, anulus, and cusp with the right ventricle. B, Parasternal long-axis view during diastole showing further prolapse of cusp/sinus and anulus with failure of coaptation of cusps. C, Apical four-chamber view showing the relation of the prolapsed sinus/cusp to the crest of the ventricular septum. LV, Left ventricle; RV, right ventricle; LA, left atrium; MV, mitral valve; LVOT, left ventricular outflow tract; LC, left coronary artery. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 7 Hemodynamic forces that influence progression of the syndrome during early systole (A), late systole (B), and diastole (C). The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 7 Hemodynamic forces that influence progression of the syndrome during early systole (A), late systole (B), and diastole (C). The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 7 Hemodynamic forces that influence progression of the syndrome during early systole (A), late systole (B), and diastole (C). The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 8, A and B. Section in the aortic root illustrating the plicating sutures used to close the VSD, elevate the anulus, reduce the size of the sinus, and restore competence of the aortic valve. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 8, A and B. Section in the aortic root illustrating the plicating sutures used to close the VSD, elevate the anulus, reduce the size of the sinus, and restore competence of the aortic valve. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions

Fig. 9 Aortogram showing prolapse of both the right coronary sinus and cusp into the right ventricle with fairly severe aortic regurgitation. The Journal of Thoracic and Cardiovascular Surgery 1997 113, 253-261DOI: (10.1016/S0022-5223(97)70321-0) Copyright © 1997 Mosby, Inc. Terms and Conditions