Simple Measuring Procedure To Determine Precise Aortic Annular Size In External Correction
Kohei Abe, Manabu Yamasaki, Kunihiko Yoshino, Hiroyasu Misumi.
St. Luke's international hospital, Tokyo, Japan.
OBJECTIVE: Precise annular fixation is essential to perform reliable valvuloplasty. There are numerous ways to fix aortic annulus during valve sparing aortic root operations and aortic valvuloplasty, however, there is little way to obtain precise annulus size if the annulus is fixed externally like reimplantation procedure or external fixation rings as Lansac ring. This problem happens because of discrepancies between aortic annuls and external circumference due mainly to difficulty of dissection around right coronary cusp. So, we invented very simple and reliable way to determine aortic annular size at the time of external correction.
METHODS: An ideal annular size is decided by leaflets’ size. After dissection around aortic root properly, braded suture pass through external aortic basal ring or bottom of dissection in which ring or graft will be located. A sizer corresponding to the ideal annular size is inserted to aortic annuls and the braded suture is tied. After removing the sizer, the suture is cut in any portion surrounding the annuls. To measure and calculate the length of suture, the ideal ring or graft side can be obtained. 1 to 6 months after the operation, annuls size was checked with cardiac CT scan.
RESULTS: Total three patients received this formula to decide graft sizes. One case was annulo aortic ectasia with tricuspid valve and two other patients were acute aortic dissection with tricuspid and bicuspid valve. Ideal annular sizes calculated from leaflet sizes were 26mm in all cases. Postoperative annular diameter from CT scan was 26.2±0.7mm.
CONCLUSIONS: This procedure is very simple and seems reliable in case of correcting aortic annulus externally.
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