ECHOCARDIOGRAPHIC RESULTS AFTER REPAIR OF INCOMPETENT BICUSPID AORTICVALVES

Introduction. Valve-related complications and the necessity of anticoa gulation after aortic valve replacement have led to new operative tech niques for correction of aortic insufficiency (Al). Fourteen patients with bicuspid aortic valves and significant Al underwent valve repair. Methods. Transthoracic echocardiography was performed preoperatively and 1 week postoperatively and in 10 patients who have come to follow- up so far. Operative procedures were triangular resection of one leafl et in all patients. Five patients had pericardial patch plasty in addi tion. Results. Mean Al decreased significantly from grade 3.5 +/- 0.1 preoperatively to 0.5 +/- 0.1 postoperatively (p < 0.001). Postoperati vely, 10 patients had no or trivial AI (0 to 0.5), and 2 patients had mild AI (1 to 1.5). Within the first week, 2 patients were reoperated on after echocardiography established significant AI. Ventricular dime nsions decreased from preoperative to postoperative and were normal af ter 1 year. At follow-up, 7 patients show no change of AI; in 3 patien ts AI increased to moderate because of dilatation of the sinus of Vals alva or the sinotubular junction. Conclusions. Reconstruction of bicus pid aortic valves is feasible with good early results. Echocardiograph y shows that asymmetric sinuses may lead to early perioperative failur es and postoperative dilatation of the proximal aorta to increasing AI . Operative techniques may have to consider the pathology of the proxi mal aorta.