Document Detail


Feasibility of valve repair for regurgitant bicuspid aortic valves--an echocardiographic study.
MedLine Citation:
PMID:  15854918     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is increasing interest in the role of valve repair for patients with isolated severe aortic regurgitation. Those with bicuspid aortic valves are suggested as most suitable for repair. Morphologic features of these valves that suggest feasibility of repair are not well defined. METHODS: Perioperative echocardiograms on 132 consecutive patients (mean age 42 +/- 12 years; 94% male), with bicuspid valves and isolated aortic regurgitation undergoing surgery at our institution were reviewed. Seventy-five patients (57%) underwent successful valve repair. Repair was attempted but unsuccessful for another 8 patients (6 intraoperatively and 2 before discharge). RESULTS: Cusp prolapse was the most common primary mechanism of regurgitation (88 patients [67%]), with 81 patients having primarily eccentrically directed regurgitation. Echocardiographic examination of 72 (55%) had evidence of cusp thickening with 40 (30%) having cusp calcification. By multivariate analysis, an eccentric regurgitant jet direction (odds ratio = 14.3; 95% confidence interval [CI] = 3.4 to 59.6), lack of cusp thickening (odds ratio = 5.9 [1.7 to 20]), lack of cusp calcification (odds ratio = 4.2; [1.1 to 16.7]) and the absence of commissural thickening (odds ratio = 4.8 [1.3 to 16.7]) were independently associated with a greater likelihood of successful valve repair. Greater cusp thickening was the only factor associated with attempted but failed repair. CONCLUSIONS: Successful repair of regurgitant bicuspid aortic valves was more feasible for those patients with eccentric regurgitant jets, those without cusp or commissural thickening or cusp calcification. Recognition of these features may enhance patient selection and improve procedural outcomes with aortic valve repair.
Authors:
Patrick J Nash; Eugene Vitvitsky; Jianbo Li; Delos M Cosgrove; Gosta Pettersson; Richard A Grimm
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  79     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-04-27     Completed Date:  2006-08-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1473-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aortic Valve / surgery*
Aortic Valve Insufficiency / surgery*,  ultrasonography
Dyspnea / etiology
Electrocardiography
Female
Heart Valve Prolapse / etiology
Heart Valve Prosthesis Implantation / methods*
Humans
Male
Middle Aged
Mitral Valve / surgery*
Patient Selection
Reproducibility of Results
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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