Objective To summarize the clinical experiences of using selfpericardial patch heightening to treat aortic valve prolapse. Methods From May 2000 to July 2007, seventeen patients with aortic valve prolapse were treated by selfpericardial patch heightening. Fifteen cases had right coronary cusp prolapse, one had left coronary cusp prolapse, and one had no coronary cusp proplapse. There were 10 cases with moderate aortic regurgitation and 7 with severe regurgitation. Autologous pericardium was continuously sutured on the proplapsed cusp by 5-0 or 6-0 Prolene suture. The transesophageal echocardiography(TEE) showed that there was few or mild aortic regurgitation during operation. Preoperative and postoperative echocardiography results were compared. Results The comparison between preoperative and postoperative echocardiography results showed that postoperative left ventricular enddiastolic diameter reduced obviously(38.3±9.6 mm vs. 47.2±10.3 mm，P=0.013)；postoperative aortic valve systolic pressure difference reduced（9.8±5.6 mm Hg vs. 10.3±5.3 mm Hg，P=0.792）; postoperative aortic valve diastolic pressure difference reduced obviously(45.7±13.6 mm Hg vs. 78.4±19.9 mm Hg，P= 0.000). Echocardiographic examination before discharge showed that 4 cases had no obvious aortic regurgitation, 9 had mild aortic regurgitation and 4 had moderate aortic regurgitation. The average followup time was 32 months(4.74 months). One case underwent aortic valve replacement because of severe aortic regurgitation 4 months later after the operation, and the rest needed no second operation. Conclusion Using selfpericardial patch heightening to treat aortic valve prolapse is a simple operative method, and it is good for young patients or small aortic annulus.
ObjectiveTo assess clinical results of single aortic cusp replacement with bovine pericardium for children with ventricular septal defect (VSD) and severe aortic regurgitation (AR). MethodsClinical data of 42 children with VSD and severe AR who underwent single aortic cusp replacement with bovine pericardium in Wuhan Asia Heart Hospital from March 2006 to September 2009 were retrospectively analyzed. There were 28 male and 14 female patients with their age of 2-14 (9.0±3.6) years. All the patients were in NYHA class Ⅱ. ResultsNo early mortality or major morbidity was recorded. Intraoperative transesophageal echocardiography showed successful repair with normal coaptation of the aortic leaflets in all the patients. AR grade was less than mild in all the patients with peak aortic valve pressure gradients of 14.2±2.8 mm Hg. All the patients were discharged from the hospital within 11 postoperative days without any adverse symptom,and were followed up for 32-72 (50±16) months. During follow-up,all the patients were in NYHA class I. There were 17 patients without AR,21 patients with mild AR and 4 patients with moderate AR. The peak aortic valve pressure gradient was 12.4±3.2 mm Hg. None of the patients died or required reoperation,and structural valve degeneration was not observed during follow-up. ConclusionSingle aortic cusp replacement with bovine pericardium can produce good hemodynamics and midterm results for children with VSD and severe AR.
Due to the lack of calcification of the aortic valve, it is difficult to provide effective support for the fixation of artificial valve in aortic stenosis characterized by leaflet thickening. There is a risk of postoperative perivalvular leakage and secondary valve implantation, which is widely regarded as a relative contraindication for transcatheter aortic valve replacement (TAVR). But aortic valvuloplasty and self-expanding transcatheter aortic valve has showed its safety and efficacy. This paper reports a patient with bicuspid aortic valve characterized by leaflet thickening treated with TAVR. After the operation, the patient’s symptom of exertional dyspnea was significantly improved, New York Heart Association class increased to Ⅱ, no perivalvular leakage was found, and the mean transaortic pressure gradient and the maximum aortic valve velocity decreased significantly.