Aortic Cusp Extension for Surgical Correction of Rheumatic Aortic Valve Insufficiency in Children

Between January 1983 and December 1996, 108 patients with ruptured aneurysms of the sinus of Valsalva underwent surgical correction in Shanghai Chest Hospital. The aneurysms ruptured into the right ventricle in 91 patients, into the right atrium in 16, and into the left atrium in 1. The aneurysm originated from the right coronary sinus in 82 patients, from the noncoronary sinus in 25, and from the left coronary sinus in 1. Associated intracardiac defects included ventricular septal defect in 52, aortic valve insufficiency in 67, and patent ductus arteriosus in 2. A ruptured aneurysm of the sinus of Valsalva without aortic valve insufficiency was approached via the cardiac chamber into which it ruptured. When the aneurysm was associated with moderate or severe aortic valve insufficiency we preferred the transaortic approach for repair. The aneurysm was excised at its base and repaired with a Dacron patch regardless of the size of the base of the aneurysm. Active surgical management of aortic valve insufficiency was performed at the initial operation using valve suspension in 25 patients with moderate aortic valve insufficiency and replacement with a mechanical valve prosthesis in 6 cases of severe aortic insufficiency. The early mortality was 2.78%. The median follow-up period was 3.9 years. Of the 72 patients who were followed up, 67 are in New. York Heart Association functional class I or II and 5 are in class III or IV due to severe aortic valve insufficiency. Considering the pathoanatomic features and hemodynamic changes associated with ruptured aneurysms of the sinus of Valsalva in Oriental patients, we advocate repairing the defect with a patch in all cases and stress the importance of active surgical management for aortic valve insufficiency at the initial surgical correction.

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Templates of flat pericardial patterns for precise aortic cusp extension

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318780482 ◽

2018 ◽

Vol 26 (5) ◽

pp. 361-366 ◽

Cited By ~ 1

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.

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