Cusp-based geometric height-oriented repair of a pediatric aortic valve

2020 ◽  
Keyword(s):  
Aortic Valve ◽  
Septal Defect ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Basal Ring ◽  
Sinotubular Junction ◽  
Effective Height ◽  
Institutional Experience ◽  
Conotruncal Anomalies ◽  
Geometrical Concepts

Progressive aortic regurgitation can occur in pediatric patients due to root dilation with conotruncal anomalies or cusp prolapse associated with a ventricular septal defect. It is treated using various approaches influenced by personal preferences and institutional experience. We applied geometrical concepts developed for adult aortic valve repair to pediatric valves. The basal ring and sinotubular junction are downsized in relation to the geometric height of the cusp by external suture annuloplasty. The length of the cusp free margin is then adjusted with central plication, guided by measuring the effective height of the cusp. This approach facilitates the reproducibility and predictability of pediatric aortic valve repair.

Intraoperative diagnosis of a quadricuspid aortic valve

2017 ◽  
Vol 26 (9) ◽  
pp. 704-706
Author(s):  
Hassan Tatari ◽  
Maziar Gholampour Dehaki ◽  
Gholamreza Omrani ◽  
Hafez Ghaheri ◽  
Alwaleed Al-Dairy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Incidental Finding ◽  
Aortic Valve Repair ◽  
Quadricuspid Aortic Valve ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Ventricular Septal Defect Closure

Quadricuspid aortic valve is a rare anomaly, and most patients require surgery for aortic regurgitation in the 5th or 6th decades of life; only a few cases of aortic valve repair in childhood have been reported. A 3-year-old boy was scheduled for ventricular septal defect closure and aortic valve repair. Quadricuspid aortic valve was an incidental finding at operation; it was repaired by joining the left anterior and right anterior cusps. At the 9-month follow-up, the patient had no more than mild aortic regurgitation. We emphasize the importance of detecting this anomaly, especially in children with aortic valve regurgitation.

scholarly journals Aortic valve repair techniques: an early UK experience

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001107 ◽  
Author(s):  
Renata Greco ◽  
Mirko Muretti ◽  
Xy Jin ◽  
Mario Petrou
Keyword(s):  
Aortic Valve ◽  
Free Edge ◽  
Connective Tissue Disorder ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Sinotubular Junction ◽  
Early Results ◽  
The Uk ◽  
Repair Techniques

ObjectivesRetrospective review of early results with aortic valve repair (AVr) techniques.Methods61 consecutive patients underwent AVr surgery at our institutions between 2008 and 2018. 14 patients had a bicuspid aortic valve and 16 had a connective tissue disorder. In 48 patients, aortic regurgitation (AR) was secondary to an aortic root and/or ascending aneurysms, while in 13 it was due to primary cusp pathologies. 13 patients underwent isolated cusp repair, 19 sinotubular junction remodelling, 25 valve-sparing root replacement (VSRR) and 4 hemiroot replacement. Cusp repair techniques included: 18 free margin plication, 18 commissural re-suspensions, 3 raphe resections and 1 free-edge reinforcement. Subcommissural annuloplasty was performed in 25 patients (42%) with a dilated annulus (>28 mm).Results50 patients (82%) left the operating theatre with no AR, 8 with mild central and 3 with mild eccentric AR. In-hospital survival was 100%. Clinical follow-up was complete at 5.08±2.29 years and all patients were alive. Transthoracic echocardiographic follow-up was complete at 2.35±1.92 years and showed the presence of a moderate AR in 10 patients (18%) and severe AR in 2 patients (4%). One of these required re-do aortic valve replacement 6 years after VSRR. Freedom from re-operation at 8 years was 88.15%±1.51%.ConclusionGood early results are achievable following AVr with acceptable medium-term outcomes. AVr surgery continues to evolve, and concentrating the experience in specialist centres in the UK is recommended.

Aortic Valve Repair for Adult Congenital Heart Disease

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Vivek Rao ◽  
Glen S. Van Arsdell ◽  
Tirone E. David ◽  
Anthony Azakie ◽  
William G. Williams
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Aortic Valve ◽  
Congenital Heart ◽  
Septal Defect ◽  
Aortic Valve Repair ◽  
Subaortic Stenosis ◽  
Valve Repair ◽  
Aortic Valve Leaflets

Background —Aortic valve–preserving procedures have resulted in excellent outcomes in selected patients, particularly those with normal aortic valve leaflets and dilated aortic roots. However, several congenital heart lesions are associated with abnormal aortic valve leaflets. The long-term results of aortic valve repair for these lesions are not well defined. Methods and Results —We reviewed the clinical records of 54 adult (age >18 years) patients who underwent repair of congenital abnormalities of the aortic valve between 1976 and September 1999. Follow-up data were available on 52 (96%) patients (mean 50±67 months, range 1 to 266). Patients underwent repair at a mean age of 34±14 years with associated diagnoses of subaortic stenosis (n=10), ventricular septal defect with prolapsing aortic valve (n=17), bicuspid aortic valve (n=23), sinus of Valsalva aneurysm (n=10), and bacterial endocarditis (n=2). There was 1 operative death (1.9%) and 3 late deaths. Survival at 5 and 10 years was 98±2% and 74±12%, respectively. Freedom from reoperation was 74±9% and 51±15% at 5 and 10 years, respectively. The presence of a ventricular septal defect predicted failure of valve repair (59% versus 22%, P =0.01). A bicuspid aortic valve, subaortic stenosis, or the requirement for mitral valve surgery did not affect outcomes. Conclusions —Aortic valve repair in adult patients with congenital heart disease can be performed with minimal morbidity and mortality rates. The medium-term results of repair are acceptable, regardless of valvular or associated pathology. However, only 31 patients (57%) demonstrated long-term competence of the aortic valve, suggesting that most adult patients with congenital aortic valve disease will eventually require aortic valve replacement.

scholarly journals Aortic root numeric model: Annulus diameter prediction of effective height and coaptation in post–aortic valve repair

2013 ◽  
Vol 145 (2) ◽  
pp. 406-411.e1 ◽  
Author(s):  
Gil Marom ◽  
Rami Haj-Ali ◽  
Moshe Rosenfeld ◽  
Hans Joachim Schäfers ◽  
Ehud Raanani
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Effective Height ◽  
Numeric Model ◽  
Annulus Diameter

scholarly journals Bicuspid aortic valve repair: outcomes after 17 years of experience

2021 ◽  
Author(s):  
Marek J Jasinski ◽  
Kinga Kosiorowska ◽  
Radoslaw Gocol ◽  
Jakub Jasinski ◽  
Rafal Nowicki ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Aortic Valve Repair ◽  
Aortic Dilatation ◽  
Years Of Experience ◽  
Valve Repair ◽  
Sinotubular Junction ◽  
Reverse Remodelling

Abstract OBJECTIVES This study presents the results of 17 years of experience with bicuspid aortic valve (BAV) repair and the analysis of factors associated with repair failure and early echocardiographic outcome. METHODS Between 2003 and 2020, a total of 206 patients [mean age: 44.5 ± 15.2 years; 152 males (74%)] with BAV insufficiency with or without aortic dilatation underwent elective aortic valve repair performed by a single surgeon with a mean follow-up of 5 ± 3.5 years. The transthoracic echocardiography examinations were reported. RESULTS There were no deaths during the hospital stay, and all but 1 patient survived the follow-up period (99.5%). Overall, 10 patients (5%) developed severe insufficiency and 2 (1%) developed aortic dilatation requiring reoperation. Freedom from reoperation at 7 years reached 91.8%. Type 2 BAV configuration [hazard ratio (HR) 3.9; 95% confidence interval (CI): 1.01–60; P = 0.049], no sinotubular junction remodelling (HR 7; 95% CI: 1.7–23; P = 0.005), no circumferential annuloplasty (HR 3.9; 95% CI: 1.01–64; P = 0.047) and leaflet resection (HR 5.7; 95% CI 1.2–13. P = 0.017) have been identified as a risk factor of redo operation. Parameters of the postoperative left ventricle reverse remodelling improved significantly early after the operation and later at 2 years evaluation. CONCLUSIONS The repair of BAV offers good short- and mid-term results providing a significant reverse left ventricular remodelling. Type 0 BAV preoperative configuration, circumferential annuloplasty and sinotubular junction remodelling are associated with better repair durability.

Aortic valve repair in patients with ventricular septal defect

2021 ◽  
Vol 36 (11) ◽  
pp. 4160-4166
Author(s):  
Ameya Kaskar ◽  
Varun Shetty ◽  
Chinnaswamy Reddy ◽  
Devi Shetty
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Aortic Valve Repair ◽  
Valve Repair

scholarly journals The Normal Aortic Valve Leaflets Effective Height in Pediatric Patients: a Guide to Aortic Valve Repair

2021 ◽  
Author(s):  
Ismail Bouhout ◽  
Vincent Chauvette ◽  
Wu Rong ◽  
Marie Josée Raboisson ◽  
Ismail El-Hamamsy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pediatric Patients ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Effective Height ◽  
Aortic Valve Leaflets
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