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Repair of Aortic Leaflet Prolapse: The “Sliding Leaflet Technique”

https://doi.org/10.1016/j.athoracsur.2003.12.104Get rights and content

Abstract

Valve-preserving aortic replacement has become an accepted therapeutic option for aortic dilatation with normal valve leaflets. The presence of a leaflet prolapse often induces the choice of a composite graft repair. In these cases, however, the repair of a leaflet prolapse is possible and represents a valuable alternative to a prosthetic valve. The conventional techniques of repair of a cusp prolapse are designed to restore coaptation through a reduction of free margin length. The sliding leaflet technique is an alternative procedure conceived to repair the prolapsed valve cusp by remodeling both the free margin and the annular insertion.

Section snippets

Technique

Transesophageal echocardiography is routinely employed to intraoperatively analyze aortic valve anatomy and function. The heart is approached through a median sternotomy or ministernotomy [3]. Normothermic cardiopulmonary bypass is established between the right atrium and the distal ascending aorta. The aorta is cross-clamped, and a left ventricular vent is inserted thought the superior right pulmonary vein. A transverse aortotomy is then performed, and cold blood cardioplegia is administered

Comment

The morphologic characteristics and the function of the aortic valve are interrelated to the aortic root that connects the left ventricle with the ascending aorta 4, 5. This complex structure has four anatomic components: the aortoventricular junction (or aortic annulus), leaflets, sinuses of Valsalva, and sinotubular junction. The aortic root is attached to contractile as well as fibrous components of the left ventricle. During systole, the interventricular septum shortens and moves inward,

Acknowledgements

We gratefully acknowledge the contribution of Arnaud Lacroix from Genzyme Biosurgery for the help in the preparation of the illustrations.

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