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J Thorac Cardiovasc Surg 1999;117:197-198
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Reconstruction of the aortic valve with autologous pericardium: An experimental study

Valve repair has several advantages over prosthetic valve replacement, including low morbidity and mortality and lower risk of thromboembolism, hemorrhage, and septic endocarditis. Different techniques of mitral valve repair have been described, with good results. ¹ Unfortunately, the results of aortic valve repair are not as favorable. In this report I describe a new technique of aortic valve reconstruction with an autologous pericardial patch, which my colleagues and I have used. In 5 cadaver hearts, autologous pericardium was fixed in 0.6% glutaraldehyde solution for 10 minutes. ² An aortotomy was used. Pericardium was cut to simulate the dimensions of the valve to be repaired on the basis of the concept of the aortic root geometry as a truncated cone. ³ The diameter at the highest point of attachment of the leaflets (sinotubular diameter) is about 20% less than the diameter at the inlet (surgical anulus diameter). During systole the sinotubular diameter increases while the inlet diameter decreases, changing the root geometry from conical to cylindrical. The reverse occurs in diastole, at which time the leaflets tilt toward the ventricle. ⁴

The noncoronary cusp is fashioned first. It is measured at its attachment line and height with a soft wire (Figs. 1, A) and the measurements are marked on the pericardium (Figs. 1, B). The resulting "a-b" is the length at the sinotubular circumference but not the true length of the cusp. Therefore, we lengthened it to the size of its projection into the surgical (inlet) circumference, which is 20% more, as mentioned earlier (Figs. 1, B). Indeed, the length of each cusp has to be equal to its projection into the inlet (annular) circumference to be able to straighten during systole when the change from the conical form to the cylindrical one occurs. The tilting of the cusps toward the aortic wall with more complete opening of the valve becomes possible because the inlet diameter at the anulus decreases. Changing the cylindrical form of the root to a conical one in diastole will make coaptation of the cusps possible.The coronary cusps are fashioned similarly and marked on pericardium. The pericardial patch is tailored along the marked line, leaving 2 to 3 mm of the tissue for the sutures (Figs. 1, B).The next step is removing the native valve and suturing the pericardial patch to the semilunar lines of the leaflet attachments (anatomic anulus) with continuous 4-0 polypropylene suture (Prolene; Ethicon, Inc, Somerville, NJ), which is passed out through the aortic wall in the commissural zones and reinforced with Dacron pledgets from the outside (Figs. 2). Then we place additional mattress sutures in the commissural zones, passing them out through the aortic wall and the same pledgets.

View larger version (0K): [in this window] [in a new window]   Fig. 1. Cusp size measurements and fashioning of the pericardial patch. A, Taking of the noncoronary cusp attachment line and height measurements with the soft wire. B, Marking of the sizes on the pericardium and fashioning of the pericardial patch.

View larger version (0K): [in this window] [in a new window]   Fig. 2. Suturing of the pericardial patch to the semilunar lines of the leaflet attachments with continuous 4-0 Prolene suture and reinforcing of the commissural zones with Dacron pledgets from outside.

We wish to pursue this study further and look forward to collaborating with others in this endeavor.

Vahe C. Gasparyan, MD
Department of Surgery
Garrison Hospital of Yerevan
26 Papazaian st 24, 375012
Yerevan, Republic of Armenia

12/8/94054

References

1. Carpentier A. Cardiac valve surgery—the "French" correction." J Thorac Cardiovasc Surg 1983;86:323-7. [Medline]
   
2. Chachques JC, Vasseur B, Perier P, Balansa J, Chauvand S, Carpentier A. A rapid method to stabilize biological material for cardiovascular surgery. Ann N Y Acad Sci 1998;529:184-6.
   
3. Sarsam MAI, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg 1993;105:435-8. [Abstract]
   
4. Thubrikar M, Pieperass WC, Shaner TW, Nolan SP. The design of the normal aortic valve. Am J Physiol 1981;241:H795-801.
   

This article has been cited by other articles:

				V. C Gasparyan and V. S Galstyan Total Reconstruction of the Mitral Valve With Autopericardium: Anatomical Study Asian Cardiovasc Thorac Ann, June 1, 2002; 10(2): 137 - 140. [Abstract] [Full Text] [PDF]

				V. C. Gasparyan METHOD OF DETERMINATION OF AORTIC VALVE PARAMETERS FOR ITS RECONSTRUCTION WITH AUTOPERICARDIUM: AN EXPERIMENTAL STUDY J. Thorac. Cardiovasc. Surg., February 1, 2000; 119(2): 386 - 387. [Full Text] [PDF]

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