title: Aortic valve repair update.
abstract: The key for successful valve repair is full understanding of the regurgitant mechanism and sufficient evaluation of the valve. Currently, multidetector computed tomography has been introduced for evaluation. The aortic valve can be analyzed in details preoperatively. The main causes of aortic regurgitation (AR) in the adult population are degenerative leaflet change and annulus dilatation. Restoration to normal structure can be accomplished mainly by plication. Central leaflet plication near the Arantius nodule is a simple technique for redundant tissue. For leaflet deficiency, pericardial patch plasty may be an option. No universal technique exists for plication of the aortic annulus. The valve-sparing aortic root replacement firmly stabilizes the ventriculo-aortic junction (VAJ) and assures repair durability even in patients with mild to moderate root dilatation. Subcommissural annuloplasty (Cabrol stitch) does not seem sufficient for the prevention of VAJ dilatation. Circumferential annuloplasties may have a greater potential. However, convenient device for annular plication is still in development. The bicuspid aortic valve is a congenital heart valve lesion. A basic technique is free margin plication of the fused leaflet. Aortic root dilatation may contribute to AR severity. Valve-sparing aortic root replacement may improve repair durability. Considering the great advances in valve repair, young patients with AR should be informed that valve repair is a promising option for surgical treatment.
authors: Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan, komiya@kchnet.or.jp.
authors: Tatsuhiko
authors: T
authors: Komiya
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities / Q000473:pathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000473:pathology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D058385:Cardiac Valve Annuloplasty / Q000639:trends*; D004108:Dilatation, Pathologic / Q000473:pathology / Q000601:surgery; D006349:Heart Valve Diseases / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D016896:Treatment Outcome
references: Hypertension. 1996 Jul;28(1):47-52
references: 8675263
references: Eur J Cardiothorac Surg. 2006 Jun;29(6):1001-6
references: 16675251
references: Ann Thorac Surg. 2008 Jun;85(6):2019-24
references: 18498812
references: J Thorac Cardiovasc Surg. 2010 Mar;139(3):660-4
references: 19691997
references: J Thorac Cardiovasc Surg. 1973 Sep;66(3):394-403
references: 4270137
references: Ann Thorac Surg. 1991 Sep;52(3):447-53; discussion 453-4
references: 1898131
references: J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S28-35; discussion S45-51
references: 21092793
references: Circulation. 1986 Sep;74(3 Pt 2):I136-42
references: 3742771
references: Eur J Cardiothorac Surg. 2012 May;41(5):1117-23; discussion 1123-4
references: 22228850
references: J Thorac Surg. 1958 Feb;35(2):192-205 passim
references: 13514815
references: J Heart Valve Dis. 2005 Nov;14 (6):752-8; discussion 758-9
references: 16359055
references: J Thorac Cardiovasc Surg. 1983 Sep;86(3):323-37
references: 6887954
references: J Thorac Cardiovasc Surg. 2010 Jun;139(6):1395-401
references: 20392456
references: J Thorac Cardiovasc Surg. 2013 Mar;145(3 Suppl):S30-4
references: 23260458
references: Eur J Cardiothorac Surg. 2005 Aug;28(2):200-5; discussion 205
references: 16039963
references: Eur J Cardiothorac Surg. 2011 Nov;40(5):1127-30
references: 21531145
references: Circulation. 1999 Nov 9;100(19 Suppl):II54-62
references: 10567279
references: J Thorac Cardiovasc Surg. 2006 Aug;132(2):436-8
references: 16872982
references: Ann Thorac Surg. 1998 Dec;66(6 Suppl):S166-9
references: 9930441
references: Am Heart J. 1991 Nov;122(5):1475-7
references: 1951018
references: Ann Thorac Surg. 1998 Oct;66(4):1269-72
references: 9800818
references: Interact Cardiovasc Thorac Surg. 2009 Jul;9(1):113-6
references: 19401293
references: Ann Thorac Surg. 2005 Jul;80(1):304-7
references: 15975387
references: Ann Thorac Surg. 2014 Aug;98(2):743-5
references: 25087813
references: J Thorac Cardiovasc Surg. 2012 Jun;143(6):1389-95
references: 21855091
references: J Thorac Cardiovasc Surg. 2010 Aug;140(2):276-284.e1
references: 20488466
references: JACC Cardiovasc Imaging. 2009 Aug;2(8):931-9
references: 19679280
references: Ann Thorac Surg. 2014 Jun;97(6):2211-3
references: 24882316
references: Ann Thorac Surg. 2004 Apr;77(4):1272-6
references: 15063250
references: Arch Mal Coeur Vaiss. 1966 Sep;59(9):1305-12
references: 4961576
references: Int J Cardiol. 1994 Jun 15;45(2):129-34
references: 7960251
references: J Am Coll Cardiol. 2010 Jun 22;55(25):2789-800
references: 20579534
references: J Thorac Cardiovasc Surg. 2011 Dec;142(6):1430-8
references: 21955470
references: Ann Thorac Surg. 2014 Apr;97(4):1235-41
references: 24433819
references: Eur J Cardiothorac Surg. 1999 Mar;15(3):302-8
references: 10333027
references: Innovations (Phila). 2011 Nov;6(6):348-54
references: 22436768
references: Circ J. 2004 May;68(5):439-43
references: 15118285
references: J Thorac Cardiovasc Surg. 2014 Jan;147(1):100-7
references: 24084289
references: Circulation. 2000 Nov 7;102(19 Suppl 3):III35-9
references: 11082359
references: Ann Thorac Surg. 2013 Jul;96(1):e25-7
references: 23816114
references: Circulation. 2009 Sep 15;120(11 Suppl):S120-6
references: 19752356
references: J Thorac Cardiovasc Surg. 2003 Sep;126(3):908-10
references: 14502193
references: Circulation. 2003 Sep 9;108 Suppl 1:II285-90
references: 12970247
references: J Thorac Cardiovasc Surg. 2004 Nov;128(5):677-83
references: 15514594
references: J Thorac Cardiovasc Surg. 2007 May;133(5):1226-33
references: 17467434
references: Circulation. 2004 Sep 14;110(11 Suppl 1):II67-73
references: 15364841
references: Ann Thorac Surg. 2009 May;87(5):1344-9; discussion 1349-50
references: 19379862
references: J Thorac Cardiovasc Surg. 2002 Jan;123(1):33-9
references: 11782753
references: J Thorac Cardiovasc Surg. 2006 Jul;132(1):32-7
references: 16798299
references: Ann Thorac Surg. 2005 Oct;80(4):1540-9
references: 16181920
references: Eur J Cardiothorac Surg. 2010 Nov;38(5):523-7
references: 20456970
references: Ann Thorac Surg. 2002 Apr;73(4):1122-9
references: 11996252
references: Eur J Cardiothorac Surg. 2006 Aug;30(2):244-9
references: 16828303
references: Ann Thorac Surg. 2006 Oct;82(4):1292-9; discussion 1300
references: 16996922
references: Br Heart J. 1978 Sep;40(9):951-7
references: 708535
references: Am Heart J. 1972 Sep;84(3):294-301
references: 5075638
references: Eur J Cardiothorac Surg. 2007 Feb;31(2):256-60
references: 17196393
references: J Thorac Cardiovasc Surg. 1991 Oct;102(4):571-6; discussion 576-7
references: 1921433
references: Ann Cardiothorac Surg. 2013 Jan;2(1):3-9
references: 23977553
references: Ann Thorac Surg. 2002 Nov;74(5):S1762-4; discussion S1792-9
references: 12440660
references: J Am Coll Cardiol. 2009 Dec 8;54(24):2312-8
references: 19958967
references: Ann Thorac Surg. 2002 Jan;73(1):29-33
references: 11834030
references: J Thorac Cardiovasc Surg. 2007 Dec;134(6):1533-8; discussion 1538-9
references: 18023678
references: J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S14-9; discussion S45-51
references: 21092781
references: Ann Thorac Surg. 2008 Jun;85(6):2012-8
references: 18498811
references: Ann Thorac Surg. 2002 Aug;74(2):438-43
references: 12173826
references: J Thorac Cardiovasc Surg. 2013 Aug;146(2):269-74
references: 22853942
references: Ann Thorac Surg. 2007 Feb;83(2):S740-5; discussion S785-90
references: 17257919
references: J Heart Valve Dis. 2002 May;11(3):383-5
references: 12056731
references: Eur J Echocardiogr. 2009 Jan;10 (1):i3-10
references: 19131496
references: Eur J Cardiothorac Surg. 2011 Apr;39(4):603-4
references: 20727779
references: Ann Thorac Surg. 2008 Mar;85(3):946-8
references: 18291176
references: Am J Cardiol. 2010 Jun 1;105(11):1629-34
references: 20494674
references: J Card Surg. 1995 Jan;10(1):1-9
references: 7696782
references: J Card Surg. 1988 Mar;3(1):23-8
references: 2980000
references: Ann Thorac Surg. 2007 Feb;83(2):S746-51; discussion S785-90
references: 17257920
references: J Thorac Cardiovasc Surg. 2007 Jul;134(1):90-8
references: 17599491
references: Ann Thorac Surg. 2014 Apr;97(4):1227-34
references: 24418204
references: Eur J Cardiothorac Surg. 2011 Nov;40(5):1097-104
references: 21420874
references: J Thorac Cardiovasc Surg. 1999 Aug;118(2):225-36
references: 10424995
references: Circulation. 2011 Jan 18;123(2):178-85
references: 21200006
references: Am J Cardiol. 1985 Feb 1;55(4):439-44
references: 3969882
references: Ann Thorac Surg. 2010 Mar;89(3):943-6
references: 20172159
references: Ann Thorac Surg. 2009 Jul;88(1):83-9
references: 19559198
references: J Thorac Cardiovasc Surg. 1977 May;73(5):716-8
references: 321881
references: J Am Coll Cardiol. 2008 Jul 1;52(1):40-9
references: 18582633
references: J Thorac Cardiovasc Surg. 2009 Feb;137(2):286-94
references: 19185138
references: Eur J Cardiothorac Surg. 2010 Jan;37(1):127-32
references: 19643618
references: Med Eng Phys. 2010 Mar;32(2):212-21
references: 20060766
references: Int J Cardiovasc Imaging. 2009 Aug;25(6):591-600
references: 19350414
references: J Nippon Med Sch. 2002 Aug;69(4):355-64
references: 12187368