International Society For Minimally Invasive Cardiothoracic Surgery

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Virtual Reality Image Evaluation For Aortic Valve Leaflet Reconstruction
Takeo Tedoriya, Ryoi Okano, Tadamasa Miyauchi, Masaomi Fukuzumi, Yuko Gatakte.
Ageo Central General Hospital, Ageo, Saitama, Japan.

OBJECTIVE: Aortic valve reconstruction with three same-sized autologous pericardial leaflets (AVLR) has been performed for patients with narrow aortic roots or contraindication for valve-prostheses. Since this procedure requires precise information of the aortic root including configuration of Valsalva sinus, we assessed physiologic-anatomical condition of the aortic root by Virtual Reality (VR) image in order to accomplish this technique with a reproducible fashion.
METHODS: VR Imaging; Axial images using enhanced ECG-triggered cardiac CT with slice thickness of 0.625mm were obtained during mid-to-end diastole. Subtracted volume rendering data of the aortic root were converted to a 3D workstation. Basic surgical technique; 1) same-sized three leaflets from autologous pericardium were prepared by original templates referred by STJ diameter, 2) new commissures and nadirs were confirmed based on VR image in cases of unbalanced aortic root, like type 0 bicuspid valve, 3) three leaflets were sutured on cusp-suture-line, 4) commissure coaptation stitches were placed between each leaflet to prevent from minor leakage and coronary orifices obstruction.
RESULTS: In 24 of 82 AVLR were evaluated by VR. In 15cases, the Valsalva sinus were unbalanced which required neo-commissure setting and adjustment of deviated nadir. Postoperative echocardiography revealed nicely opening of new-leaflet with no AR, although we had one case without 3D analysis who had taken down to AVR due to mild AR. A median follow-up period was 38 months, while we have no re-do due to aortic valve failure.
CONCLUSIONS: VR image analysis had notably provides valuable information for understanding of precise anatomy of the aortic root for AVLR.

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