Valve-sparing reconstruction of a congenital bicuspid aortic valve with severe calcified aortic stenosis

摘要

Bicuspid aortic valve is now known to be the most common congenital lesion affecting the human heart. Bicuspid aortic valve is well known to cause calcified aortic stenosis. Valve-sparing reconstruction in cases of bicuspid valves, represents a promising alternative to prosthetic valve replacement. Reconstruction of the bicuspid valve is feasible with good results by the technique of valve repair.In this study we present our valve-sparing reconstruction technique of a congenital bicuspid aortic valve with severe calcified aortic stenosis. Introduction The bicuspid aortic valve affects 1 to 2% of the population and may be complicated by aortic stenosis (1). Aortic valve replacement is the standard procedure in patients with aortic valve pathology. Currently, isolated reconstruction of a regurgitant bicuspid aortic valve can be performed with adequate early results (2). Although long-term results for both biological and mechanical heart valves could be improved, a valve-sparing operation has several advantages especially in young patients (3). In patients with a bicuspid aortic valve, the aortic valvular pathology can be corrected by the valve reconstruction. Case Presentation Our case was a 10-year-old boy. After his birth he was suffering from intermittent cyanosis of the extremities and the lips. Transthoracic echocardiography revealed a bicuspid aortic valve with severe stenosis where the peak pressure gradient was measured as 60 mm Hg. Left ventricular end-diastolic and end-systolic diameters were measured as 44 and 23 mm, respectively. No aortic regurgitation was identified. Ejection fraction was measured as 83%. Cardiac catheterization revealed no additional pathology. Our patient was taken to the operating room with these findings. Following a median sternotomy,pericardium was opened longitudinally. After heparinization, extra-corporeal circulation was established between the venae cavae and the ascending aorta. A cross clamp was placed on aorta and by antegrade intermittent isothermic blood cardioplegia from aortic root,cardiac arrest was established.Hypothermia was moderate (29oc). Standard aortotomy was made. Aortic valve was bicuspid, thickened and calcific in structure. Additionally, the commissures were adhered (Figure 1).