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Revista Brasileira de Cirurgia Cardiovascular
On-line version ISSN 1678-9741
SANT´ANNA, João Ricardo et al. Anterior and posterior enlargement of the aortic annulus for valve replacement. Rev Bras Cir Cardiovasc [online]. 2002, vol.17, n.1, pp. 35-46. ISSN 1678-9741. http://dx.doi.org/10.1590/S0102-76382002000100007.
OBJECTIVES: To present a technique for anterior and posterior enlargement of the aortic anulus using individual patches and results in 26 patients. METHOD: Aortic valve surgery is performed with conventional cardiopulmonary bypass. For posterior enlargement, the longitudinal aortotomy is extended inferiorly and posteriosly in the mean portion of the noncoronary sinus, until the anterior mitral leaflet. Anterior enlargement results from incision between the two coronary ostium, extended in the left side of the ventricular septum for 2 cm. Two patches of bovine pericardium are sutured in the distal portion of the anterior and posterior incisions and the aortic prosthesis is fixed. Aorta is reconstructed with the patchs. Combined cardiac defects are corrected. RESULTS: Procedure resulted in increase of the annulus diameter from 18.0 + 2.6 mmHg to 24.5 + 2.1 mmHg (p<0.01). During operation, one patient required coronary revascularization owing to ostial obstruction. After the operation, one patient was reoperated owing bleeding (3.8 % morbidity) and one died with sepsys (3.8% hospital mortality). In the late post-operative period (mean follow up: 24 months) there were no deaths or reoperations. Functional class improved for all followed up patients and 22 (84.3 %) are in class I (NYHA). For patients with stenosis of the native valve or prosthesis, mean peak systolic transvalvar gradient (measured by Doppler echocardiography) decreased from a preoperative value of 87.3 + 20.8 mmHg to 25.9 + 10,3 mmHg (p<0.01). CONCLUSION: Increase in diameter of the aortic annulus results from anterior and posterior enlargement using individual patches. The procedure should be considered for enlargement of the aortic annulus and reconstruction of the left ventricular outflow tract.
Keywords : Aortic valve [surgery]; Aortic valve stenosis [surgery]; Heart valve prosthesis, implantation.