The Small Annulus Problem During Aortic Valve Replacement

Year 1981, Volume: 34 Issue: 1, 29 - 36, 11.08.1981

İlhan Günay

Abstract

Aortic valve replacement is technicaliy easy and a relatively safe procedure in sitnations which the aortic root is of normal or wider ihan normal size, Ho- Wever, in situations which the aortic annulus iş small, use of small cardiaç valve prostheses produces significant sistoliç gradients. When ball yalves are used, the cage may be an obstacle for the closure of the aortotomy incision, or even if this incision is closed, sistolic pressure gradient may increase due to the narrowing bet- ween the cage and aortic wall.
In our clinic 378 aorüc valve replacementis were done for isolated or multipl valve lesions between 1965 and 1980, In only seven of these cases the aorfic roof was widened with a patch of approximately 1 x 3 cm Size. In this article we ha- ve discussed the small aortic annulus problem and the methods to solve it,

Keywords

Aortic root , valve replacement , heart valves

Valv Replasmanı Sırasında Küçük Aortik Anulus Problemi

Abstract

Aort kökü normal veya normalden daha geniş olan vakalarda aort valv rep- lasmanı kolaylıkla ve emniyet içinde başarılır. Buna karşılık aort anulusu küçük olan vakalarda ufak numaralarda yapay kalp kapaklarının kullanılması aort kapa- ğı üzerinde önemli derecede sistolik basınç farkına yol açar. Ayrıca toplu bir kapak kullanıldığı zaman, kapağın kafes kısmı aortotomi insizyonunun rahatlıkla kapatıl- masına engel olabilir veya kapatıldığı takdirde, bunun mekanik sakıncaları görüle- bilir,
Bilim dalımızda 1965 ve 1980 yılları arasında 378 hastaya sekiz ayrı tipte pro- tez kullanılarak aort valv replasmanı yapılmıştır. Bunlar arasında aort kökü yama ile genişletilen yedi vaka nedeniyle literatürdeki küçük aort anulusu problemine
yaklaşım şekilleri gözden geçirilmiştir.

Keywords

Aort kökü , valv replasmanı , kalp kapakları

References

• 1. Björk VO, ve ark. : Evaluation of the 21 mm Björk-Shiley tilting disc valve in patients with narrow aortic roots, Scand J Cardiovasc Surg 7 : 203, 1973
• 2.Björk VO, Henze A, Holmgren A : Five years experience witli the Björk - Shiley tl ting disc valve in isolated aortiç valve disease, | Thoraç Cardiovasc Surg 68 : 393, 1974
• 3. Blank RH, ve ark. : Method of managing the small aortic annulus during valve repTacement, Ann Thorac Surg 22 : 356, 1976
• 4. Byrd CL, Yahr WZ, Greenberg II : Long term resulis of «simple» thrombectomy for thrombosed Björk - Shiley aortic valve prostheses, Ann Thorac Surg 20 : 265, i975
• 5. Hatcher CR, Ir. :Aortic valve replacemeni : The problem of the small aortic annulus, Ann Tborac Surg 22 : 400, 1976
• 6. Yones Fİ, ve ark. : Haemodynamic and cinical evaluation of the Hancock xenograft bi10. oprosthesis for aortic valve replacement (with emphasis on management of the small aörtiç root), J Thorac Cardiovasc Surg 75 : 300, 1978
• 7. Konno S, ve ark. : A new method for prosthetiç valve replacement in congenital aortic stenosis asşociated with hypoplasia of the aortic valve ring, J Thorac Cardiovasc Surg 70 : 909, 1975
• 8. Manugulan $, Abu-Aishah N, Neitzel J : Patch enlargement of the aortic and mitral valve rings with aortiç and mitral dayble valve replacement, I Thorac Cardiovasc Surg 78 : 394, 1979
• 9. Manuguian S, Seybold-Epting W : Patch enlargement of the aortic valve ring by extending the aortic incision into the anteror mitral leaflet, J Thorac Cardiovasc Surg 78 : 402, 1979
• 10. McGoon DC : Surgical treatment of supravalvuar aortic stenosis, J Thorac Cardıovasc Surg 55 : 231, 1968
• 11. Morris DC, ve ark. : Hemodynamic evaluation ol ihe porcine Xenograft aortiç valve, Am. J Cardiol 37 : 157, 1976
• 12. Najafi, H., ve ark. : Narrow aortic root somplicating aortic valve replacement, Arch Surg 99 : 690, 1969
• 13. Nicks R, Cartmill 'T, Bernstein L : Hypoplasia of the aortic root, Thorax 25 : 339, 1970
• 14. Sohma, Y, Inoue T : Right coronary cüsp approach. Patch enlargement of narrow aortiç annulus and aortic valve replacement, Jpn J Thorac Surg 28 : 41, 1975
• 15. Zuhdi 'N, Hawley W, Voehl V : Porcine aortic valves as replacemenis for human heart valves, Ann Thorac Surg 17 : 479, 1974