Doss Mirko, Moid Reinhard, Wood Jeffrey Paul, Miskovic Aleksandra, Martens Sven, Moritz Anton
Department of Thoracic and Cardiovascular Surgery, J. W. Goethe University, Frankfurt am Main, Germany.
Ann Thorac Surg. 2005 Jul;80(1):304-7. doi: 10.1016/j.athoracsur.2004.08.038.
Reoperation rates after repair of bicuspid aortic valves are higher than for mitral valve reconstruction. Secondary changes and small coaptation surface render repair unreliable. Satisfactory results have been reported for patch augmentation for tricuspid aortic valves. We have applied this technique for the repair of bicuspid aortic valves.
Our technique retains the bicuspid morphology of the incompetent aortic valve. A strip of glutaraldehyde-fixed pericardium is sutured to the free edge of the fused leaflet. A large coaptation surface is created, and competence of the bicuspid valve is achieved.
Sixteen patients underwent reconstruction of their bicuspid aortic valves by pericardial patch augmentation. There were no intraoperative or postoperative deaths. The degree of aortic regurgitation was none to trivial for all patients at a mean follow-up of 3.1 +/- 3.4 months. Planimetric effective orifice areas ranged above 2 cm2. Mean aortic gradients were 8.2 +/- 4.8 mm Hg, and the mean height of coaptation surface was 14.7 +/- 2.1 mm.
The pericardial patch augmentation technique increases coaptation surface, and thus provides reliable early competence of reconstructed bicuspid aortic valves.
二叶式主动脉瓣修复术后的再次手术率高于二尖瓣重建术。继发改变和较小的瓣叶对合面积使得修复不可靠。对于三尖瓣主动脉瓣的补片扩大术，已有满意的结果报道。我们已将此技术应用于二叶式主动脉瓣的修复。
我们的技术保留了功能不全主动脉瓣的二叶形态。将一条戊二醛固定的心包条缝合至融合瓣叶的游离缘。形成一个大的瓣叶对合面积，从而实现二叶式瓣膜的功能。
16例患者接受了心包补片扩大术修复其二叶式主动脉瓣。无术中或术后死亡病例。在平均3.1±3.4个月的随访中，所有患者的主动脉反流程度均为无至轻微。平面测量的有效瓣口面积均大于2平方厘米。平均主动脉压差为8.2±4.8毫米汞柱，平均瓣叶对合面高度为14.7±2.1毫米。
心包补片扩大术可增加瓣叶对合面积，从而为重建的二叶式主动脉瓣提供可靠的早期功能。
