Kondov Stoyan, Kari Fabian Alexander, Czerny Martin, Siepe Matthias
Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Interact Cardiovasc Thorac Surg. 2017 Oct 1;25(4):671-673. doi: 10.1093/icvts/ivx117.
We present our surgical strategy in a patient with a bicuspid aortic valve Type I (R/N), aortic root aneurysm and papillary fibroelastoma on the aortic valve's cusp. He underwent valve-sparing aortic root replacement (David V Procedure); we also removed the papillary fibroelastoma from the fused right- and non-coronary cusp. In this case, we used a 34-mm straight Dacron graft for root replacement and an aortic annulus downsized to 30 mm. We use Hegar dilatators for the intraoperative measurement of the aortic annulus. The subvalvular sutures are pledged U-sutures and our usual technique in bicuspid aortic valve is to take 2 on each commissure and 5 on each side so that we end up with 12. For the reimplantation of the aortic rim, we prefer a semi-circumferential suture with a small needle. We plicate the non-fused left cusp, which is our reference for the later reconstruction of the common right- and non-coronary cusp. The key strategy of our bicuspid valve reconstruction is aiming at a 180° non-fused commissure orientation and cusp plication. The coronary ostia and aortic root are marked intraoperatively with a radiopaque marker to facilitate postoperative diagnostics and any future interventions including later catheter-based valve interventions.
我们介绍了一位患有 I 型（R/N）二叶式主动脉瓣、主动脉根部瘤以及主动脉瓣瓣叶上有乳头状纤维弹性瘤患者的手术策略。他接受了保留瓣膜的主动脉根部置换术（David V 手术）；我们还从融合的右冠状动脉瓣叶和无冠状动脉瓣叶上切除了乳头状纤维弹性瘤。在这种情况下，我们使用 34 毫米的直涤纶移植物进行根部置换，并将主动脉瓣环缩小至 30 毫米。我们使用黑格扩张器在术中测量主动脉瓣环。瓣下缝线采用 U 形褥式缝线，我们在二叶式主动脉瓣手术中的常规技术是在每个瓣叶交界点处缝 2 针，在每侧缝 5 针，这样总共缝 12 针。对于主动脉边缘的再植入，我们更喜欢用小针进行半圆周缝合。我们折叠未融合的左瓣叶，这是我们后来重建共同的右冠状动脉瓣叶和无冠状动脉瓣叶的参考。我们二叶式瓣膜重建的关键策略是使瓣叶交界点呈 180°未融合方向并进行瓣叶折叠。术中用不透射线的标记物标记冠状动脉开口和主动脉根部，以方便术后诊断以及未来的任何干预措施，包括后续基于导管的瓣膜干预。
