Aortic Valve Reconstruction With Three Same-sized Autologous Pericardial Leaflets Guided By 3d Hologram
Takeo Tedoriya, Kenichi Kamiya, Tadamasa Miyauchi, Masaomi Fukuzumi, Yuko Gatate.
Ageo Central General Hospital, Ageo, Saitama, Japan.
BACKGROUND Aortic valve reconstruction with three same-sized autologous pericardial leaflets has been performed for patients with narrow aortic roots or contraindication for valve-prostheses. We assessed physiologic-anatomical condition of the aortic root by 3D hologram in order to accomplish this technique with a reproducible fashion. METHODS 3D Hologram Imaging; Enrolled patients underwent cardiac CT. Axial images with slice thickness of 0.625mm were obtained during mid-to-end diastole. Subtracted volume rendering data of the aortic root were converted to stereolithography (STL) file in Visalius3D. Preoperatively the aortic root was assessed in order to decide neo-commissure and offsetting of deviated nadir in cases of unbalanced aortic root. Basic surgical technique was; 1) transverse ascending aortotomy, 2) same-sized three pieces of leaflets from autologous pericardium treated by 0.6 % glutaraldehyde for 6 minutes were tailored to original templates referred by STJ diameter, 3) the new commissures and nadirs were confirmed based on 3D hologram image, 4) in case the non-coronary nadir deviated toward the left ventricle, a crescent form Valsalva plication were required, 5) three leaflets were sutured on the cusp-suture-line by 4-0 continuous fashion in a ratio of 3:2 from the nadir to commissure height, 1:1 in commissure height, 6) commissure coaptation stitches were placed between each leaflet to prevent from minor leakage and coronary orifices obstruction, finally 7) STJ is fixed by a pericardial stripe as prevention of STJ dilatation. RESULTS Valsalva plication and commissure adjustment navigated by 3D hologram was accomplished as a preoperative plan. Postoperative mean pressure-gradient was 8.5 mmHg without any development of AR during follow-up. CONCLUSIONS Preoperative evaluation by 3D-Hologram had notably provides valuable information for adjustment of neo-commissure and nadir in our aortic valve reconstruction using three same-sized leaflets.
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