초록접수 현황
| 15F-272 | Video session발표 |
Valve Sparing Root Replacement : Aortic Root Remodeling with External Subvalvular Ring Annuloplasty
조상호¹, 김대현¹, 곽영태¹, 박주철¹, 윤효철², 김수철², 김범식²
Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Gangdong-gu, Republic of Korea¹, Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea²
Background : Multiple techniques of aortic valve sparing procedures for aortic root aneurysms try to restore the complex interplay of aortic valve and root function in order to improve durability of the repair. We report here a case of aortic root remodeling with subvalvular annuloplasty in a 68 year-old man with annuloaortic ectasia.
Methods : A 69 year-old man was referred to our hospital for surgical management of aortic root aneurysm found by echocardiography during a preoperative work-up for spinal surgery. Trans-thoracic echocardiography revealed an enlarged sinus of Valsalva 56 mm in diameter with moderate aortic regurgitation. The left ventricular ejection fraction was 65% without regional wall motion abnormality. The maximal diameter of the mid-ascending aorta and distal ascending aorta was 50 and 40 mm, respectively.
Results : Under moderate hypothermic extracorporeal circulation, valve sparing root replacement was performed. The aortic valve annulus measured with hegar dilators was 27mm. pliable non retracted cusps are suitable for valve repair. The remodeling technique was performed using a Gelweave Valsalva™ graft 26 mm. Plicating stitches for cusp resuspension was added on the free edge of the right coronary leaflet and the non coronary leaflet until an suitable effective height was obtained. Diameter of the external subvalvular ring was undersized by one size relative to the internal aortic annular base diameter measured with Hegar dilators. The prosthetic flexible ring was placed in the subvalvular position with the six anchoring stitches. Both coronary buttons were anastomosed to the corresponding ‘neosinuses’ of Valsalva using 5-0 Prolene and the graft was anastomosed to the distal ascending aorta. On the transesophageal echocardiography after weaning from CPB, no aortic regurgitation was confirmed. The postoperative course was uneventful.
Conclusion : The two original valve sparing procedures - remodeling of the aortic root and reimplantation of the aortic valve - focused on root reconstruction to reduce the dilated root diameters in order to restore proper valve function. The reimplantation technique performs external subvalvular aortic annuloplasty but withdraws the sinuses of Valsalva and includes the interleaflet triangles within a graft tube, thus impairing root dynamics. In contrast, the remodeling technique provides more physiologic movements of the cusps within three reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles, but without addressing annular base dilation. Therefore, a standardized approach to aortic valve repair was described associating a physiological remodeling of the root, with resuspension of cusp effective height and a subvalvular aortic annuloplasty using an external ring. We report a case of aortic root remodeling with subvalvular annuloplasty in a 68 year-old man with annuloaortic ectasia.
Methods : A 69 year-old man was referred to our hospital for surgical management of aortic root aneurysm found by echocardiography during a preoperative work-up for spinal surgery. Trans-thoracic echocardiography revealed an enlarged sinus of Valsalva 56 mm in diameter with moderate aortic regurgitation. The left ventricular ejection fraction was 65% without regional wall motion abnormality. The maximal diameter of the mid-ascending aorta and distal ascending aorta was 50 and 40 mm, respectively.
Results : Under moderate hypothermic extracorporeal circulation, valve sparing root replacement was performed. The aortic valve annulus measured with hegar dilators was 27mm. pliable non retracted cusps are suitable for valve repair. The remodeling technique was performed using a Gelweave Valsalva™ graft 26 mm. Plicating stitches for cusp resuspension was added on the free edge of the right coronary leaflet and the non coronary leaflet until an suitable effective height was obtained. Diameter of the external subvalvular ring was undersized by one size relative to the internal aortic annular base diameter measured with Hegar dilators. The prosthetic flexible ring was placed in the subvalvular position with the six anchoring stitches. Both coronary buttons were anastomosed to the corresponding ‘neosinuses’ of Valsalva using 5-0 Prolene and the graft was anastomosed to the distal ascending aorta. On the transesophageal echocardiography after weaning from CPB, no aortic regurgitation was confirmed. The postoperative course was uneventful.
Conclusion : The two original valve sparing procedures - remodeling of the aortic root and reimplantation of the aortic valve - focused on root reconstruction to reduce the dilated root diameters in order to restore proper valve function. The reimplantation technique performs external subvalvular aortic annuloplasty but withdraws the sinuses of Valsalva and includes the interleaflet triangles within a graft tube, thus impairing root dynamics. In contrast, the remodeling technique provides more physiologic movements of the cusps within three reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles, but without addressing annular base dilation. Therefore, a standardized approach to aortic valve repair was described associating a physiological remodeling of the root, with resuspension of cusp effective height and a subvalvular aortic annuloplasty using an external ring. We report a case of aortic root remodeling with subvalvular annuloplasty in a 68 year-old man with annuloaortic ectasia.
책임저자: 곽영태
Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Gangdong-gu, Republic of Korea
연락처 : 조상호 , Tel: 02-440-6158 , E-mail : sinan75@khnmc.or.kr
