title: Mid-term results in patients having tricuspidization of the quadricuspid aortic valve.
abstract: BACKGROUND
  Quadricuspid aortic valve (QAV) is a rare congenital anomaly. We investigate the mid-term results of aortic valve reconstruction by tricuspidization in patients with QAV.
  
  
  METHODS
  We analyzed the outcome of eight consecutive patients who underwent aortic valve reconstruction surgery (AVRS) with pericardial leaflets with symptomatic quadricuspid aortic valve (QAV) disease between December 2007 and May 2012. AVRS consists of leaflet reconstruction and fixation of the sino-tubular junction in order to maintain coaptation of the new valve.
  
  
  RESULTS
  Six males and two females were included; ages ranged from 19 to 63 years (mean age, 51 years). According to Hurwitz and Roberts's classification, three patients had type A, three patients had type B, one patient had type C, and one patient had type E. All patients had significant aortic regurgitation (AR): moderate in three patients, moderate to severe in one patient, and severe in four patients. Concomitant ascending aorta wrapping with an artificial vascular graft was performed in one case. There was no occurrence of mortality during the follow-up period (42.4 ± 18.0 months). No redo-operation was required. The NYHA functional class showed improvement from 2.1 ± 0.2 to 1.1 ± 0.2 (p= 0.008). The latest echocardiograms showed AR absent or trivial in seven patients, and mild in one patient. The aortic valve orifice area index (AVAI) was 1.03 ± 0.49 cm2/m2. Compared with preoperative echocardiograms, the left ventricular (LV) ejection fraction showed improvement from 57.6 ± 17.0 to 63.7 ± 13.2% (p=0.036); the end-diastolic and end-systolic LV dimensions showed a significant decrease, from 63.5 ± 9.6 to 49.5 ± 3.1 mm (p=0.012) and 43.6 ± 11.8 to 32.1 ± 5.4 mm (p=0.012), respectively.
  
  
  CONCLUSIONS
  In patients with QAV, AVRS with tricuspidization showed satisfactory early and mid-term results. Long-term follow-up will be necessary in order to study the durability of AVRS; however, it can be considered as a potential standard procedure.
authors: Meong Gun
authors: MG
authors: Song
authors: Hyun Suk
authors: HS
authors: Yang
authors: Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namgu, Daegu 705-035, South Korea. dhlee@med.yu.ac.kr.
authors: Dong Hyup
authors: DH
authors: Lee
authors: Je Kyoun
authors: JK
authors: Shin
authors: Hyun Keun
authors: HK
authors: Chee
authors: Jun Seok
authors: JS
authors: Kim
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D001807:Blood Vessel Prosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006349:Heart Valve Diseases / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods; D016277:Ventricular Function, Left; D055815:Young Adult