Templates of flat pericardial patterns for precise aortic cusp extension

2018 ◽  
Vol 26 (5) ◽  
pp. 361-366 ◽  
Author(s):  
Mohammad Bashar Izzat ◽  
Mohammad Mouath Alkhayat
Keyword(s):  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Pericardial Patch ◽  
Aortic Valve Insufficiency ◽  
Aortic Cusp ◽  
Bovine Pericardial Patch ◽  
Natural Geometry ◽  
Intraoperative Transesophageal Echocardiography ◽  
Valve Insufficiency

Background Aortic cusp extension is a subjective and operator-dependent technique. In order to facilitate surgical correction of aortic cusp retraction and reestablishment of adequate cusp coaptation, we sought to develop new templates that can be used to cut flat pericardial sheets into precise cusp extension patches. Methods Each template was designed as a two-dimensional unwrap of the natural geometry of a complete aortic cusp, and a series of templates were made available to correspond with all potential aortic cusp sizes. Based on these templates, aortic cusp extension was performed in 2 patients (aged 54 and 43 years) with significant retraction of the noncoronary aortic cusps and severe aortic valve insufficiency. In each patient, extension of the retracted native noncoronary cusp was undertaken using a bovine pericardial patch that matched the size of adjacent nondiseased native aortic cusps. Results Achieving geometrically perfect aortic cusp extensions was uncomplicated, and intraoperative transesophageal echocardiography confirmed satisfactory aortic valve repairs (aortic insufficiency < 1+ and low transvalvular gradients). Early follow-up transthoracic echocardiography confirmed that all valve cusps met at similar heights in the aortic root, and that their excursions were virtually identical. Conclusions The newly designed templates can be used to cut flat pericardial sheets into exact cusp extension patches, and initial clinical experience indicates that they are useful in performing precise aortic cusp extension procedures and restoring adequate aortic valve competence.

scholarly journals Midterm follow-up dynamic echocardiography evaluation after aortic valve repair for aortic valve insufficiency

2012 ◽  
Vol 14 (6) ◽  
pp. 721-724 ◽  
Author(s):  
G. D'Ancona ◽  
A. Amaducci ◽  
J. Prodromo ◽  
F. Pirone ◽  
M. Follis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Repair ◽  
Aortic Valve Insufficiency ◽  
Valve Repair ◽  
Valve Insufficiency

Clinical and Echocardiographic Outcomes After Aortic Valve Repair Surgery

2019 ◽  
Vol 14 (3) ◽  
pp. 209-217 ◽  
Author(s):  
Eilon Ram ◽  
Boris Orlov ◽  
Ami Shinfeld ◽  
Alexander Kogan ◽  
Leonid Sternik ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Clinical Outcomes ◽  
Multivariable Analysis ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Pericardial Patch ◽  
Valve Repair ◽  
Significant Independent Predictor ◽  
Autologous Pericardial Patch

Objective To assess early and late clinical outcomes in patients who underwent aortic valve repair surgery for aortic valve insufficiency, and to investigate predictors for recurrence. Methods Of 151 consecutive patients who underwent aortic valve repair surgery for varying degrees of aortic insufficiency (AI) in our department between 2004 and 2018, 60 (40%) underwent aortic root replacement, 71 (47%) aortic cusp plication, 31 (20%) subcommissural annuloplasty, 29 (19%) circular annuloplasty, and 28 (18%) autologous pericardial patch augmentation. Results One patient died in the hospital (0.7%). Mean clinical and echocardiographic follow-up was 62±43 months (range 1 to 159) and 50 ± 40 months (range 1 to 158), respectively. The overall survival rate was 99.3% at 1 year and 98% at 5 years of follow-up. Seventeen patients (11.3%) had recurrent severe AI, and all of them underwent reoperation with a mean duration to reoperation of 35 ± 39 months. Risk factors for the development of recurrent significant AI (≥3) or reoperation, by univariable analysis, were unicuspid or bicuspid aortic valve (AV) ( P = 0.018), the use of subcommissural annuloplasty ( P = 0.010), the need for cusp repair ( P = 0.001), and the use of pericardial patch augmentation ( P < 0.001). By multivariable analysis only the use of pericardial patch augmentation emerged as a significant independent predictor for the development of recurrent significant AI (≥3) or reoperation ( P = 0.020). Conclusion AV repair can be performed with low morbidity and mortality, with good early and late clinical outcomes. However, in our experience there was a significant rate of recurrent AI especially in patients who underwent cusp augmentation using glutaraldehyde-treated autologous pericardial patch.

scholarly journals Cardiac Gated Computed Tomography Used to Confirm Iatrogenic Aortic Valve Leaflet Perforation after Mitral Valve Replacement

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Luke Oakley ◽  
Kathleen Love ◽  
Alfredo Ramirez ◽  
Gilbert Boswell ◽  
Keshav Nayak
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Rapid Diagnosis ◽  
Valve Leaflet ◽  
Iatrogenic Perforation ◽  
Aortic Valve Leaflet ◽  
Intraoperative Transesophageal Echocardiography

Aortic insufficiency from iatrogenic valve perforation from nonaortic valve operations is rarely reported despite the prevalence of these procedures. Rapid diagnosis of these defects is essential to prevent deterioration of cardiac function. In this paper, we describe a young man who reported to our institution after two open cardiac surgeries with new aortic regurgitation found to be due to an iatrogenic perforation of his noncoronary aortic valve cusp. This defect was not appreciated by previous intraoperative transesophageal echocardiography and was inadequately visualized on follow-up transthoracic and transesophageal echocardiograms. In contrast, cardiac gated computed tomography clearly visualized the defect and its surrounding structures. This case highlights the utility of cardiac gated computed tomography for cases of suspected valvular perforation when echocardiography is not readily available or inadequate imaging is obtained.

To the semiotics of aortic stenosis

1927 ◽  
Vol 23 (12) ◽  
pp. 1210-1215
Author(s):  
A. B. Khavkin
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Heart Defects ◽  
Aortic Insufficiency ◽  
Pure Form ◽  
Aortic Valve Insufficiency ◽  
Valve Insufficiency

Aortic stenosis, in particular its pure form, not combined with aortic valve insufficiency, is the rarest of extrauterine heart defects, so rare that, as Prof. S.S. Zimnitsky points out, in some authors' statistics "this defect does not appear at all". Indeed, in Schnitt's statistics, as well as in Guttmann's statistics cited by Killbs, and in Killbs' own statistics, stenosis ostii aortae is completely silent. Hirschfeider found this defect in only 3% of all his cases, and always in combination with aortic insufficiency. Gerhardt reported this defect 19 times out of 300 cases.

Transcatheter closure of a residual aorto-left ventricular tunnel: report of a case with a 6-year follow-up

2017 ◽  
Vol 27 (8) ◽  
pp. 1618-1621
Author(s):  
Milan Djukic ◽  
Stefan A. Djordjevic ◽  
Ingo Dähnert
Keyword(s):  
Aortic Valve ◽  
Surgical Repair ◽  
Transcatheter Closure ◽  
Left Ventricular ◽  
Aortic Valve Insufficiency ◽  
Amplatzer Duct Occluder ◽  
Cardiac Defect ◽  
Surgical Closure ◽  
Valve Insufficiency

AbstractAorto-left ventricular tunnel is an exceedingly rare congenital cardiac defect. Early surgical closure is the treatment of choice. Residual or recurrent tunnel and aortic valve insufficiency are well-recognised complications after surgical repair. In this article, we report on successful transcatheter closure of a residual aorto-left ventricular tunnel using an Amplatzer duct occluder in a 7-year-old boy. The outcome after 6 years of follow-up is encouraging.

scholarly journals Management of aortic insufficiency in patients with left ventricular assist device ̶ a retrospective analysis

2018 ◽  
Author(s):  
Hartmuth B. Bittner
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Assist Device ◽  
De Novo ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Aortic Valve Insufficiency ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Valve Insufficiency

Background Aortic insufficiency is increasingly recognized as a complication of left ventricular assist device (LVAD) support and may lead to clinical decompensation requiring correction. This article describes experiences in managing patients presenting with concomitant aortic insufficiency and with de novo aortic insufficiency following left ventricular assist device implantations. Methods All patients undergoing LVAD implantation between 2012 and 2014 were included in this retrospective analysis if aortic valve insufficiency was present on implantation or newly developed (de novo) after implantation. Moderate to severe aortic valve insufficiency was corrected at implantation. Results The data of 39 patients were included. At the time of LVAD implantation, moderate to severe aortic valve insufficiency was present in 3 patients and was corrected by bioprosthetic valve replacement (2 patients) and by bioprosthetic valve replacement associated with ascending aorta with hemi arch replacement with a graft due to ascending aortic aneurysm (one patient). Four patients developed moderate to severe aortic insufficiency after LVAD surgery. Treatment with conservative medical management was successful in 3 patients. One patient underwent transcatheter aortic valve occlusion using an Amplatzer closure device after failure of medical management. Conclusions Concomitant aortic valve replacement with LVAD implantation is a safe and viable option in managing aortic valve insufficiency. De novo aortic insufficiency may lead to recurrent heart failure and presents a clinical treatment challenge following successful LVAD support; the most appropriate and effective treatment option awaits definition.

Sign in / Sign up

Export Citation Format

Share Document