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The Journal of Cardiovascular Surgery 2000 April;41(2):263-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Tri-foliate pericardial patch repair of supra-valvular aortic stenosis

Shatapathy P., Kamath S. G., Aggarwal B. K., Yawari G. A.

From the Department of Cardiovascular and Thoracic Surgery Kasturba Medical College & Hospital Manipal, India


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Con­ven­tional aor­to­plasty pro­ce­dures do not ­fully ­restore the ­normal ­anatomy in ­supra-val­vular ­aortic sten­osis (SVAS), ­which ­involves the ­sinus rim as ­well as the ­aortic ­cusps. A tri-­sinus ­repair of ­this con­di­tion is pro­posed to ­restore the ­three ­intercom­mis­sural dis­tances to ­normal and ade­quately ­replace the ­tissue ­loss of the ­sinuses, for a sym­met­rical recon­struc­tion of the ­aortic ­root. Two ­patients, ­aged 3 and 11 ­years, ­with local­ized ­type of ­supra-val­vular ­aortic sten­osis ­were oper­ated, in May 1994 and Feb­ruary 1996. The ­aortic ste­nosing ­ring was ­opened up at ­three ­points, by ­extending the inci­sion ­into all the ­three ­sinuses, and the ­defect was ­repaired ­with in ­situ autol­o­gous per­i­car­dium, in a tri-fol­iate ­fashion. ­This ­repair ­achieved a sym­met­rical recon­struc­tion of the ­aortic ­root and the sys­tolic pres­sure gra­dient was com­pletely abol­ished. Post­op­er­a­tive ­aortic ­root angio­gram, in the ­older of the two ­patients, ­revealed a ­normal ­appearing ­aortic ­root. The ­patients ­have ­been fol­lowed-up for 51 ­months and 30 ­months respec­tively. Ech­o­car­di­og­raphy ­showed com­pe­tent ­aortic ­valves in ­both the ­patients ­without any sys­tolic gra­dient ­across the ­aortic ­valve. A tri-­sinus ­repair of the ­aorta in ­SVAS ­results in a sym­met­rical recon­struc­tion of the ­aortic ­root by ­restoring the ­normal ­intercom­mis­sural dis­tances of all the ­three ­cusps. It ­also abol­ishes the sys­tolic pres­sure gra­dient. Autol­o­gous ­untreated per­i­car­dium ­lends ­itself ­easily for tail­oring ­into a tri-fol­iate ­patch.

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