title: Aortic valve leaflet replacement with bovine pericardium to preserve native dynamic capabilities of the aortic annulus.
abstract: Valve replacement is typically the most appropriate option for treating aortic valve stenotic insufficiency. However, neither mechanical nor bioprosthetic replacement components preserve the circumferential expansion and contraction of a native aortic annulus during the cardiac cycle, because the prosthetic ring is affixed to the annulus. A 64-year-old man presented with a bicuspid and stenotic aortic valve, and the native annulus was too small to accommodate a porcine replacement valve. We fashioned new aortic leaflets from bovine pericardium with use of a template, and we affixed the sinotubular junction with use of inner and outer stabilization rings. Postoperative echocardiograms revealed coaptation of the 3 new leaflets with no regurgitation. At the patient's 5.5-year follow-up examination, echocardiograms showed flexible leaflet movement with a coaptation height of 7 mm, and expansion and contraction of the aortic annulus similar to that of a normal native annulus. The transvalvular pressure gradient was insignificant. If long-term durability of the new leaflets is confirmed, this method of leaflet replacement and fixation of the sinotubular junction might serve as an acceptable alternative to valve replacement in the treatment of aortic valve stenosis. We describe the patient's case and present our methods and observations.
authors: Department of Thoracic and Cardiovascular Surgery (Drs. Choi, K. Kim, and M. Kim) and Division of Cardiology (Dr. W. Kim), Chonbuk National University Medical School, Jeonju, 561-712 Chonbuk; and Department of Thoracic and Cardiovascular Surgery (Drs. M. Lee and S. Lee), Wonkwang University School of Medicine, Iksan, 570-711 Chonbuk; Republic of Korea.
authors: Kyung Hwa
authors: KH
authors: Kim
authors: Jong Bum
authors: JB
authors: Choi
authors: Min Ho
authors: MH
authors: Kim
authors: Won Ho
authors: WH
authors: Kim
authors: Mi Kyung
authors: MK
authors: Lee
authors: Sam Youn
authors: SY
authors: Lee
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D001705:Bioprosthesis; D058385:Cardiac Valve Annuloplasty / Q000295:instrumentation*; D002417:Cattle; D015150:Echocardiography, Doppler; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation*; D011474:Prosthesis Design; D016896:Treatment Outcome