PDF(Pubmed)
Abstract：
BACKGROUND: The current study presents a novel and precise surgical technique for complete reconstruction of the aortic valve using glutaraldehyde-treated autologous pericardium in a patient with aortic valve disease and endocarditis. The technique aims to provide a more effective and reproducible method for aortic valve repair, with the goal of improving outcomes and quality of life for patients with aortic valve disease.
METHODS: A 35-year-old Iranian male with aortic valve disease and endocarditis underwent aortic valve reconstruction surgery. Preoperative echocardiography showed a degenerative aortic valve with severe regurgitation, reduced left ventricular ejection fraction, and specific aortic root dimensions. The surgical technique involved precise measurements and calculations to design the size and shape of the new aortic valve cusps using autologous pericardium, with the goal of optimizing coaptation and function. The surgeon calculated the intercommissural distance based on the aortic annulus diameter to determine cusp size and shape. He tailored the pericardial cusps to have a height equal to 80% of the coaptation margin length. Detailed suturing techniques were used to ensure proper alignment and coaptation of the new cusps. Intraoperative evaluation of the valve function using suction and transesophageal echocardiography showed good coaptation and minimal residual regurgitation. At the 3-year follow-up, the patient had a well-functioning aortic valve with only trivial leak and was in satisfactory clinical condition.
CONCLUSIONS: Glutaraldehyde-treated autologous pericardium is a validated leaflet alternative, and the causes of its failure are late annular dilatation and other technique breakdowns. Current evidence reveals that aortic valve reconstruction with glutaraldehyde-treated autologous pericardium is associated with many advantages with the potential to improve patient outcomes and quality of life. Further clinical studies are warranted to evaluate the long-term durability and efficacy of this approach.
METHODS: A 35-year-old Iranian male with aortic valve disease and endocarditis underwent aortic valve reconstruction surgery. Preoperative echocardiography showed a degenerative aortic valve with severe regurgitation, reduced left ventricular ejection fraction, and specific aortic root dimensions. The surgical technique involved precise measurements and calculations to design the size and shape of the new aortic valve cusps using autologous pericardium, with the goal of optimizing coaptation and function. The surgeon calculated the intercommissural distance based on the aortic annulus diameter to determine cusp size and shape. He tailored the pericardial cusps to have a height equal to 80% of the coaptation margin length. Detailed suturing techniques were used to ensure proper alignment and coaptation of the new cusps. Intraoperative evaluation of the valve function using suction and transesophageal echocardiography showed good coaptation and minimal residual regurgitation. At the 3-year follow-up, the patient had a well-functioning aortic valve with only trivial leak and was in satisfactory clinical condition.
CONCLUSIONS: Glutaraldehyde-treated autologous pericardium is a validated leaflet alternative, and the causes of its failure are late annular dilatation and other technique breakdowns. Current evidence reveals that aortic valve reconstruction with glutaraldehyde-treated autologous pericardium is associated with many advantages with the potential to improve patient outcomes and quality of life. Further clinical studies are warranted to evaluate the long-term durability and efficacy of this approach.
摘要：
背景：目前的研究提出了一种新颖而精确的手术技术，用于在主动脉瓣疾病和心内膜炎患者中使用戊二醛处理的自体心包完全重建主动脉瓣。该技术旨在为主动脉瓣修复提供一种更有效和可重复的方法，目的是改善主动脉瓣疾病患者的预后和生活质量。
方法：一名35岁的伊朗男性主动脉瓣疾病和心内膜炎患者接受了主动脉瓣重建手术。术前超声心动图显示主动脉瓣变性伴严重反流，左心室射血分数降低,和特定的主动脉根部尺寸。手术技术涉及精确测量和计算，以使用自体心包设计新的主动脉瓣尖的大小和形状，以优化接合和功能为目标。外科医生基于主动脉瓣环直径计算连合间距离以确定尖点大小和形状。他调整了心包尖端，使其高度等于接合边缘长度的80％。使用详细的缝合技术来确保新尖的正确对齐和接合。术中使用抽吸和经食管超声心动图评估瓣膜功能显示良好的接合和最小的残留反流。在3年的随访中，患者的主动脉瓣功能良好，只有轻微的渗漏，临床状况令人满意。
结论：戊二醛处理的自体心包是一种有效的小叶替代品，其失败的原因是晚期环形扩张和其他技术故障。目前的证据表明，用戊二醛处理的自体心包重建主动脉瓣具有许多优点，具有改善患者预后和生活质量的潜力。需要进一步的临床研究来评估这种方法的长期耐久性和有效性。
方法：一名35岁的伊朗男性主动脉瓣疾病和心内膜炎患者接受了主动脉瓣重建手术。术前超声心动图显示主动脉瓣变性伴严重反流，左心室射血分数降低,和特定的主动脉根部尺寸。手术技术涉及精确测量和计算，以使用自体心包设计新的主动脉瓣尖的大小和形状，以优化接合和功能为目标。外科医生基于主动脉瓣环直径计算连合间距离以确定尖点大小和形状。他调整了心包尖端，使其高度等于接合边缘长度的80％。使用详细的缝合技术来确保新尖的正确对齐和接合。术中使用抽吸和经食管超声心动图评估瓣膜功能显示良好的接合和最小的残留反流。在3年的随访中，患者的主动脉瓣功能良好，只有轻微的渗漏，临床状况令人满意。
结论：戊二醛处理的自体心包是一种有效的小叶替代品，其失败的原因是晚期环形扩张和其他技术故障。目前的证据表明，用戊二醛处理的自体心包重建主动脉瓣具有许多优点，具有改善患者预后和生活质量的潜力。需要进一步的临床研究来评估这种方法的长期耐久性和有效性。
