Echocardiographic results after repair of incompetent bicuspid aortic valves.
BACKGROUND
Valve-related complications and the necessity of anticoagulation after aortic valve replacement have led to new operative techniques for correction of aortic insufficiency (AI). Fourteen patients with bicuspid aortic valves and significant AI underwent valve repair.


METHODS
Transthoracic echocardiography was performed preoperatively and 1 week postoperatively and in 10 patients who have come to follow-up so far. Operative procedures were triangular resection of one leaflet in all patients. Five patients had pericardial patch plasty in addition.


RESULTS
Mean AI decreased significantly from grade 3.5 +/- 0.1 preoperatively to 0.5 +/- 0.1 postoperatively (p < 0.001). Postoperatively, 10 patients had no or trivial AI (0 to 0.5), and 2 patients had mild AI (1 to 1.5). Within the first week, 2 patients were reoperated on after echocardiography established significant AI. Ventricular dimensions decreased from preoperative to postoperative and were normal after 1 year. At follow-up, 7 patients show no change of AI; in 3 patients AI increased to moderate because of dilatation of the sinus of Valsalva or the sinotubular junction.


CONCLUSIONS
Reconstruction of bicuspid aortic valves is feasible with good early results. Echocardiography shows that asymmetric sinuses may lead to early perioperative failures and postoperative dilatation of the proximal aorta to increasing AI. Operative techniques may have to consider the pathology of the proximal aorta.
Moidl
R
R
Department of Cardiothoracic Surgery, University of Vienna, Austria.
Moritz
A
A
Simon
P
P
Kupilik
N
N
Wolner
E
E
Mohl
W
W
D000293:Adolescent; D000328:Adult; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003971:Diastole; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004452:Echocardiography; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D012074:Remission Induction; D012086:Reoperation; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging