Plastia valvar aórtica por ampliação de válvula com pericárdio bovino: nota prévia

Abstract

RESUMO : Apresenta-se, preliminarmente, uma técnica para a correção do refluxo valvar aórtico pela ampliação de uma ou mais válvulas com pericárdio bovino. Após estudo experimental em peças animais isoladas, a técnica foi empregada, com sucesso, em uma paciente. DESCRITORES : valvas cardíacas, cirurgia; próteses valvulares cardíacas, cirurgia; próteses valvulares cardíacas, biológicas.

Reconstructive surgery of the aortic valve

“…Owing to the lack of an ideal valvar substitute and, in particular, motivated by the good results initially achieved using mitral valve reconstructive surgery [1][2][3][4][5][6][7][8][9] and, consequently the aortic valve [10][11][12][13], we decided, from 1990, to give priority to repair surgery. Thus, prostheses were utilized only for cases in which the structural valvar alterations did not allow any type of repair [16].…”

“…In the second group, a series of procedures whose greatest justification is to permit adequate coaptation of the three cuspids to distribute the forces and dissipate stress. Among these, the following can be utilized: a) commissural [18,19] and circumferential annuloplasty [10]; b) enlargement of the cuspids: increasing the free edge [11,[20][21][22][23][24] or inserting a graft between the annulus and the base of the cuspid [12,13,15]; c) cuspid replacement [25][26][27]; d) suspension of the cuspid by commissural plication [28,29]; triangular resection [10,14] or remodeling of the Valsalva sinus **. Figures 1 and 2 illustrate some of these procedures.…”

“…The lack of an ideal replacement valve and the good results achieved with reconstruction of atrioventricular valves serve as an incentive for some surgeons to become attracted to the challenge of reconstructive surgery of the aortic valve [10][11][12][13][14][15].…”

Reconstructive surgery for aortic valve disease

“…C) Combined, stenotic and insufficient aortic valveAs the presence of fibrotic cusp retraction is commonplace in these lesions, particularly when due to rheumatic etiology, the plastic correction is usually burdened by the progression of the rheumatic disease. For combined lesions, besides liberation of the commissural fusions and removal of fibrotic and calcified areas, valve competence can be restored by using bovine pericardium to patch the gap resulting from detaching the cusp from its implantation base in between the commissures 31,32 . An alternative technique, proposed by Al Fagih, et al 30 and Duran…”

“…Clinical application of glutaraldehyde treated bovine pericardium came next and due to its great availability this material came to be extensively used for valve replacement and repair, particularly of the mitral valve [26][27][28][29] . Application of this biologic tissue for surgical repair of the aortic valve damaged either by rheumatic fever or by congenital or degenerative disease has been very exciting [30][31][32] .…”