Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes

Boodhwani, Munir; Kerchove, Laurent de; Glineur, David; Poncelet, Alain; Rubay, Jean; Astarci, Parla; Verhelst, Robert; Noirhomme, Philippe; Khoury, Gébrine El

doi:10.1016/j.jtcvs.2008.08.054

Cited by 310 publications

(206 citation statements)

References 14 publications

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“…As the AV apparatus dilates, or when there is prolapse of a cusp, the ability for the aortic cusps to coapt decreases, resulting in AI. 6 Results of our study showed that the CoapSA in patients with AI also decreases significantly, which intuitively makes perfect sense. A second important application of this technique is in the immediate postoperative evaluation of AV repair.…”

Section: Discussionsupporting

confidence: 60%

“…The valves in these patients are defined in the surgical literature as type 1a, 1b, or 1c. 6 The mechanism of AI was found to be type 1a (dilatation of the sinotubular junction [STJ]) in five patients and type 1b (aortic root and STJ dilatation) in five patients. Associated cusp prolapse (type 2) was also found in one of the patients with type 1a disease and in three of the patients with type 1b disease.…”

Section: Study Populationmentioning

confidence: 99%

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Measuring aortic valve coaptation surface area using three-dimensional transesophageal echocardiography

Sohmer

Hudson

Atherstone

et al. 2012

Can J Anesth/J Can Anesth

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Background As aortic valve (AV) repairs become more sophisticated, surgeons need increasingly detailed information about the structure and function of this valve. Unlike two-dimensional transesophageal echocardiography (2D-TEE), using three-dimensional (3D)-TEE makes it possible to image the entire AV. We hypothesized that measuring coaptation surface area (CoapSA) would be feasible and reproducible, and CoapSA would decrease in patients with aortic insufficiency. Methods We developed a new technique to calculate the AV-CoapSA using 3D-TEE. We measured the coaptation surfaces between the right coronary cusp/left coronary cusp, right coronary cusp/non-coronary cusp, and left coronary cusp/non-coronary cusp in ten normal AVs and ten AVs with moderate-severe aortic insufficiency (AI). Since computer models have previously shown that CoapSA is trapezoidal, we used the formula: trapezoid area = length 9 (medial coaptation height ? lateral coaptation height)/2. The total CoapSA was calculated by adding all three areas. To adjust for valve size, we indexed the value to the diameter of the ventricular aortic junction (VAJ). Measurements were performed by two observers. Results The intra-observer correlation was 0.84 for one observer (P \ 0.0001) and 0.93 for the other (P \ 0.0001). The inter-observer correlation was 0.87 (P \ 0.0001). In normal valves, the CoapSA [mean total (standard deviation)] was significantly greater than in the insufficient valves [1.61 (0.31) cm 2 vs 1.03 (0.22) cm 2 , respectively; P \ 0.001]. After indexing for the VAJ diameter, the total CoapSA remained significantly greater in normal valves than in insufficient valves. Conclusion In this proof of concept study, we present a new and innovative technique to measure AV-CoapSA using 3D-TEE. It is reproducible and shows decreased CoapSA in patients with AI. Coaptation surface area may provide insight into mechanisms of AI and may have predictive value following AV repair. RésuméContexte Alors que les re´parations de valve aortique (VA) deviennent de plus en plus perfectionne´es, les chirurgiens ont besoin d'informations de plus en plus de´taille´es concernant la structure et le fonctionnement de cette valve. L'e´chocardiographie transoesophagienne tridimensionnelle (E´TO-3D) permet d'obtenir une image de la VA dans son inte´gralite´, ce qui n'est pas le cas avec l'E´TO bidimensionnelle (2D). Nous avons e´mis l'hypothe`se qu'il serait faisable de mesurer la surface de coaptation (SCoap), que cette mesure pourrait eˆtre reproduite, et que

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Section: Discussionsupporting

confidence: 60%

Section: Study Populationmentioning

confidence: 99%

Measuring aortic valve coaptation surface area using three-dimensional transesophageal echocardiography

Sohmer

Hudson

Atherstone

et al. 2012

Can J Anesth/J Can Anesth

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“…While the Carpentier classification for mitral valve regurgitation has seen widespread application, in recent years, a similar functional classification system for aortic regurgitation has been developed by El Khoury and colleagues [8]. In this system, the aortic valve is viewed as two components, the annulus and valve leaflets, the former consisting of the ventriculo-aortic junction and the sinotubular junction.…”

Section: Classification Of Aortic Regurgitationmentioning

confidence: 99%

“…prolapse) or III) restriction in leaflet motion such as that in bicuspid, rheumatic and other degenerative processes. One or more of these lesions may be present in to a given case of aortic regurgitation [8].…”

Section: Classification Of Aortic Regurgitationmentioning

confidence: 99%

“…However, almost a decade later, the group's latest report shows that 40% of patients had at least one leaflet free margin plicated while 22% underwent reinforcement of the free margin with a running polytetreafluoroethylene suture [12]. In a seminal publication, the Brussels Group, recently presented their results on 264 patients undergoing elective aortic valve repair for regurgitation occuring in isolation (43%) and in combination with aortic dilatation (57%) [8]. Leaflet repair techniques included free margin plication, resuspension as well as trangular resection with pericardial patch repair, while combinations of valve-sparing procedures, sinotubular plication, and subcommissural annuloplasty was used to stabilise the annulus.…”

Section: Valve-sparing Root Replacement With Concomitant Valve Repairmentioning

confidence: 99%

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