Izzat Mohammad Bashar, Alkhayat Mohammad Mouath
1 Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria.
2 Department of Engineering Design, Faculty of Mechanical and Electrical Engineering, Damascus University, Damascus, Syria.
Asian Cardiovasc Thorac Ann. 2018 Jun;26(5):361-366. doi: 10.1177/0218492318780482. Epub 2018 Jun 11.
Background Aortic cusp extension is a subjective and operator-dependent technique. In order to facilitate surgical correction of aortic cusp retraction and reestablishment of adequate cusp coaptation, we sought to develop new templates that can be used to cut flat pericardial sheets into precise cusp extension patches. Methods Each template was designed as a two-dimensional unwrap of the natural geometry of a complete aortic cusp, and a series of templates were made available to correspond with all potential aortic cusp sizes. Based on these templates, aortic cusp extension was performed in 2 patients (aged 54 and 43 years) with significant retraction of the noncoronary aortic cusps and severe aortic valve insufficiency. In each patient, extension of the retracted native noncoronary cusp was undertaken using a bovine pericardial patch that matched the size of adjacent nondiseased native aortic cusps. Results Achieving geometrically perfect aortic cusp extensions was uncomplicated, and intraoperative transesophageal echocardiography confirmed satisfactory aortic valve repairs (aortic insufficiency < 1+ and low transvalvular gradients). Early follow-up transthoracic echocardiography confirmed that all valve cusps met at similar heights in the aortic root, and that their excursions were virtually identical. Conclusions The newly designed templates can be used to cut flat pericardial sheets into exact cusp extension patches, and initial clinical experience indicates that they are useful in performing precise aortic cusp extension procedures and restoring adequate aortic valve competence.
背景 主动脉瓣叶延长是一种主观且依赖操作者的技术。为便于外科矫正主动脉瓣叶回缩并重新建立足够的瓣叶对合，我们试图开发新的模板，可用于将平坦的心包片切割成精确的瓣叶延长补片。方法 每个模板设计为完整主动脉瓣叶自然几何形状的二维展开图，并制作了一系列模板以对应所有可能的主动脉瓣叶尺寸。基于这些模板，对2例（年龄分别为54岁和43岁）非冠状动脉主动脉瓣叶明显回缩且伴有严重主动脉瓣关闭不全的患者进行了主动脉瓣叶延长术。在每例患者中，使用与相邻未患病的天然主动脉瓣叶尺寸匹配的牛心包补片对回缩的天然非冠状动脉瓣叶进行延长。结果 实现几何形状完美的主动脉瓣叶延长并不复杂，术中经食管超声心动图证实主动脉瓣修复满意（主动脉瓣关闭不全<1+且跨瓣压差低）。早期随访经胸超声心动图证实，所有瓣叶在主动脉根部的高度相似，且其活动几乎相同。结论 新设计的模板可用于将平坦的心包片切割成精确的瓣叶延长补片，初步临床经验表明它们有助于进行精确的主动脉瓣叶延长手术并恢复足够的主动脉瓣功能。
