Technique of aortic valve repair for aortic regurgitation and preoperative echocardiographic assessment

KUNIHARA Takashi

doi:10.3179/jjmu.jjmu.r.112

The guideline on surgical intervention for aortic regurgitation or aortic root disease is formulated supposing that aortic valve replacement is the only alternative. As early intervention is advantageous in the case of aortic valve repair, echocardiographers play an important role. Each type can theoretically be repaired. Type Ia can be treated by ascending aortic replacement, but other types can often be combined. Accurate measurement of the root dimension is essential for use of valve-sparing root replacement in type Ib disease. Type Ic is appropriately treated by annuloplasty, but each one has both advantages and disadvantages. External suture annuloplasty is a simple procedure that entails plication of a ventriculo-aortic junction, whereas external ring annuloplasty is technically demanding but involves plication of a basal ring. Internal rigid ring annuloplasty allows simple plication of a basal ring, but the concern remains with regard to the effect of a rigid ring in close proximity to the delicate aortic cusps. The clinical outcomes of patch repair for type Id lesions is favorable; however, their preoperative diagnosis is difficult in the presence of multiple jets. Type II, the most common type, can easily be repaired by central plication of the cusp. It can easily be diagnosed by eccentric jet, lower effective height, and cusp bending. Type III requires cusp extension with the pericardium. However, use of the pericardium has emerged as a risk of failure. Thus, echocardiographic diagnosis is very important; however, cusp height tends to be underestimated. In the diagnosis of bicuspid valve, echocardiographers play the most important role in avoiding stenosis, arranging commissure orientation, and avoiding cusp bulging. We hope that as many aortic valves as possible will be preserved by standardizing aortic valve repair and revising the guideline.

Technique of aortic valve repair for aortic regurgitation and preoperative echocardiographic assessment

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