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.