Preservation of the Bicuspid Aortic Valve

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Presentation transcript:

Preservation of the Bicuspid Aortic Valve Hans-Joachim Schäfers, MD, PhD, Diana Aicher, MD, Frank Langer, MD, Henning F. Lausberg, MD The Annals of Thoracic Surgery Volume 83, Issue 2, Pages S740-S745 (February 2007) DOI: 10.1016/j.athoracsur.2006.11.017 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Typical aortogram with normal aorta and preserved sinotubular narrowing. (B) Aortogram in a patient with mild dilatation of the ascending aorta. There is no sinotubular narrowing. (C) Aortogram of a patient with marked dilatation involving also the aortic root. The Annals of Thoracic Surgery 2007 83, S740-S745DOI: (10.1016/j.athoracsur.2006.11.017) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Schematic drawing of the aortic root with a calliper introduced to measure the height difference between aortic insertion and free margin (“effective height”). (AN = annulus; eH = effective height; LH = leaflet height; STJ = sinotubular junction.) (B) Intraoperative photograph of bicuspid valve after root remodeling has been performed. The calliper is placed at the aortic insertion of the noncoronary cusp with its long arm, the short arm rests on the free cusp margin. The height difference can be measured in millimeters. (C) Intraoperative transesophageal echocardiogram of a patient after repair of a bicuspid aortic valve. A dotted line is drawn at the level of the aortic insertions. The height between the free cusp margin and the aortic insertion can be measured perpendicular to the insertion level. The Annals of Thoracic Surgery 2007 83, S740-S745DOI: (10.1016/j.athoracsur.2006.11.017) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan-Meier analysis of freedom from aortic regurgitation of II or greater in the three groups: AVR+asc (dashed line) = separate aortic valve repair plus supracommissural aortic replacement; AVR (solid line) = isolated aortic valve repair. (Dotted line = remodeling.) The Annals of Thoracic Surgery 2007 83, S740-S745DOI: (10.1016/j.athoracsur.2006.11.017) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Kaplan-Meier analysis of freedom from aortic valve replacement in the three groups: AVR+asc (dashed line) = separate aortic valve repair plus supracommissural aortic replacement; AVR (solid line) = isolated aortic valve repair. (Dotted line = remodeling.) The Annals of Thoracic Surgery 2007 83, S740-S745DOI: (10.1016/j.athoracsur.2006.11.017) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Typical echocardiogram of a patient with symmetric prolapse after separate valve repair and aortic replacement. The dotted line marks the coaptation level of the free margins, the solid line, the level of the aortic insertion. The most striking finding is an abnormally low height difference of 4 mm between central cusps and aortic insertion. The Annals of Thoracic Surgery 2007 83, S740-S745DOI: (10.1016/j.athoracsur.2006.11.017) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions