Ni Qiming, Fan Liwen, Li Wei, Ren Shunan, Meng Xu, Yang Tianyang
Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, China.
Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 200127 Shanghai, China.
Rev Cardiovasc Med. 2023 Jun 14;24(6):174. doi: 10.31083/j.rcm2406174. eCollection 2023 Jun.
The ideal position of suture annuloplasty relative to the aortic annulus (internal or external) remains unclear. This study aimed to investigate the effectiveness of internal and external suture annuloplasty for isolated type 1 bicuspid aortic valve (BAV) repair. Electrocardiogram (ECG)-gated computed tomography (CT) was used to compare the two techniques and analyze their impact on the aortic annulus.
We retrospectively analyzed 20 patients who underwent isolated type 1 BAV repair with either internal or external suture annuloplasty. Each group included 10 patients with comparable clinical features. Preoperative and postoperative ECG-gated CT scans were performed to assess the anatomical relationship between the ventricular-aortic junction (VAJ) and virtual basal ring (VBR), and to measure the height of annuloplasty from the VBR at predefined landmarks in both groups. Perioperative annular geometries, including annular area and perimeter, were measured to quantify the impact of annuloplasty on annular expansibility. The discrepancy between the postoperative annular dimension and size of the Hegar dilator were compared between groups to evaluate the effectiveness of annuloplasty.
In both groups, VAJ was higher than VBR at the right coronary (RC) ostium (7.7 3.3 mm) and the raphe (7.9 1.5 mm). The height from the VBR to the external suture annuloplasty shared a similar pattern at the RC ostium and raphe (5.3 1.1 mm and 4.8 1.0 mm, respectively). In contrast, the height differences were minimal for these landmarks in the internal group. Postoperative annular area expansibility decreased in the internal group compared to preoperative levels (4.9 2.3% 8.9 5.5%, = 0.038), while no significant change was found in the external group (7.6 4.1% 6.5 2.8%, = 0.473). The internal group showed less area discrepancy between the VBR and the Hegar dilator both at systole (10.1 3.7% 30.1 16.6%, = 0.004) and diastole (5.7 4.9% 20.9 14.5%, = 0.009) compared to the external group.
Internal suture annuloplasty results in better positioning relative to the VBR than external suture annuloplasty due to the absence of VAJ interference. While this results in more precise annular reduction and less expansibility in the short term, a long-term follow-up evaluation is necessary to assess its effectiveness.
缝线环成形术相对于主动脉瓣环的理想位置（内部或外部）仍不明确。本研究旨在探讨内部和外部缝线环成形术治疗孤立性1型二叶式主动脉瓣（BAV）修复的有效性。采用心电图（ECG）门控计算机断层扫描（CT）比较这两种技术，并分析它们对主动脉瓣环的影响。
我们回顾性分析了20例行孤立性1型BAV修复术并采用内部或外部缝线环成形术的患者。每组包括10例具有可比临床特征的患者。术前行ECG门控CT扫描，评估心室-主动脉连接（VAJ）与虚拟基环（VBR）之间的解剖关系，并测量两组在预定义标志点处从VBR到环成形术的高度。测量围手术期瓣环几何形状，包括瓣环面积和周长，以量化环成形术对瓣环扩张性的影响。比较两组术后瓣环尺寸与黑加扩张器尺寸之间的差异，以评估环成形术的有效性。
在两组中，右冠状动脉（RC）开口处（7.7±3.3mm）和瓣缝处（7.9±1.5mm）的VAJ高于VBR。从VBR到外部缝线环成形术的高度在RC开口处和瓣缝处呈现相似模式（分别为5.3±1.1mm和4.8±1.0mm）。相比之下，内部组中这些标志点的高度差异最小。与术前水平相比，内部组术后瓣环面积扩张性降低（4.9±2.3% vs 8.9±5.5%，P=0.038），而外部组未发现显著变化（7.6±4.1% vs 6.5±2.8%，P=0.473）。与外部组相比，内部组在收缩期（10.1±3.7% vs 30.1±16.6%，P=0.004）和舒张期（5.7±4.9% vs 20.9±14.5%，P=0.009）时VBR与黑加扩张器之间的面积差异更小。
由于不存在VAJ干扰，内部缝线环成形术相对于VBR的定位比外部缝线环成形术更好。虽然这在短期内导致更精确的瓣环缩小和更小的扩张性，但需要长期随访评估来评估其有效性。
