title: Feasibility of intraoperative water testing in aortic valve repair: Direct visualization from left ventricle with a videoscope.
abstract: We describe a simple method to assess the aortic valve using a videoscope inserted in the left ventricle (LV-VS) during valve-sparing root replacement. The aim of this study was to evaluate the feasibility of this technique by comparing it with the findings of postoperative transesophageal echocardiography (TEE).
  
  
  
  Thirty-six patients (29 male, mean age 45.4 ± 20.1 years) undergoing aortic root reimplantation were assessed intraoperatively with LV-VS. The LV-VS was inserted from the right upper pulmonary vein into the left ventricle and set toward the aortic valve. After completion of graft implantation, inspection was performed with LV-VS by pressurizing the neo-sinus before attachment of coronary arteries. Valve competency evaluated by LV-VS was compared with postoperative TEE findings, according to the group of cusp morphologies. Group 1 included 26 patients with tricuspid aortic valve, and group 2 included 9 patients with bicuspid aortic valve and 1 quadricuspid aortic valve.
  
  
  
  The grade of aortic regurgitation (AR) improved from 2.9 ± 1.6 preoperatively to 0.33 ± 0.6 postoperatively (P < .001 vs preoperatively). In 4 patients, LV-VS was used only before repair. In group 1, intraoperative LV-VS showed a competent valve in 20 and an incompetent valve in 3 patients, and postoperative TEE showed non/trivial AR in 15, mild AR in 5, and mild-to-moderate AR in 3 patients. In group 2, 9 patients achieved a competent valve on intraoperative LV-VS and non/trivial AR on postoperative TEE.
  
  
  
  Intraoperative direct inspection with LV-VS is a feasible method for confirming the completion of cusp repair.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miyahara
authors.affiliation: Division of Cardiovascular Surgery, Takatsuki General Hospital, Takatsuki, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Oka
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Matsumori
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: yokita@med.kobe-u.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging* / Q000601:surgery; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
keywords: aortic cusp repair; aortic regurgitation; aortic root replacement; echocardiography; intraoperative assessment