Tricuspidization of Quadricuspid Aortic Valve

Department of Cardiac Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia. Electronic address: .
The Annals of thoracic surgery (Impact Factor: 3.45). 04/2013; 95(4):1453-5. DOI: 10.1016/j.athoracsur.2012.08.019
Source: PubMed

ABSTRACT A 65-year-old woman presented with New York Heart Association class II-III symptoms, no overt signs of heart failure, and echocardiographic findings of a quadricuspid aortic valve, Hurwitz type C, with severe aortic regurgitation, dilated left ventricle (7 cm), and moderate left ventricular dysfunction (45%). She subsequently underwent tricuspidization of the valve at the level of the abnormal commissure with subcommissural annuloplasty. At her 6-week follow-up visit, the patient was in New York Heart Association class I, with reduction of left ventricular diastolic dimensions, trace aortic regurgitation, and good mobility of the leaflets.

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    ABSTRACT: Quadricuspid aortic valve (QAV) is a rare congenital anomaly. We investigate the mid-term results of aortic valve reconstruction by tricuspidization in patients with QAV. We analyzed the outcome of eight consecutive patients who underwent aortic valve reconstruction surgery (AVRS) with pericardial leaflets with symptomatic quadricuspid aortic valve (QAV) disease between December 2007 and May 2012. AVRS consists of leaflet reconstruction and fixation of the sino-tubular junction in order to maintain coaptation of the new valve. Six males and two females were included; ages ranged from 19 to 63 years (mean age, 51 years). According to Hurwitz and Roberts's classification, three patients had type A, three patients had type B, one patient had type C, and one patient had type E. All patients had significant aortic regurgitation (AR): moderate in three patients, moderate to severe in one patient, and severe in four patients. Concomitant ascending aorta wrapping with an artificial vascular graft was performed in one case. There was no occurrence of mortality during the follow-up period (42.4 +/- 18.0 months). No redo-operation was required. The NYHA functional class showed improvement from 2.1 +/- 0.2 to 1.1 +/- 0.2 (p = 0.008). The latest echocardiograms showed AR absent or trivial in seven patients, and mild in one patient. The aortic valve orifice area index (AVAI) was 1.03 +/- 0.49 cm2/m2. Compared with preoperative echocardiograms, the left ventricular (LV) ejection fraction showed improvement from 57.6 +/- 17.0 to 63.7 +/- 13.2% (p = 0.036); the end-diastolic and end-systolic LV dimensions showed a significant decrease, from 63.5 +/- 9.6 to 49.5 +/- 3.1 mm (p = 0.012) and 43.6 +/- 11.8 to 32.1 +/- 5.4 mm (p = 0.012), respectively. In patients with QAV, AVRS with tricuspidization showed satisfactory early and mid-term results. Long-term follow-up will be necessary in order to study the durability of AVRS; however, it can be considered as a potential standard procedure.
    Journal of Cardiothoracic Surgery 02/2014; 9(1):29. DOI:10.1186/1749-8090-9-29 · 1.02 Impact Factor
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    ABSTRACT: OBJECTIVES: Truncal valve regurgitation remains a short- and long-term risk factor for patients with truncus arteriosus. There are limited data available on techniques and outcomes of truncal valve repair (TVR). The aim of this study was to report our experience with TVR in patients of all ages. METHODS: From 1997 to 2012, 36 patients (13 neonates, 30 children and 3 adults) underwent TVR for significant regurgitation. RESULTS: There were 3 early deaths (8%), all of which were in neonates. Twenty-two patients had a quadricuspid, 13 a tricuspid and 1 a bicuspid truncal valve before repair. Valve repair improved regurgitation in 31 of 36 repairs. The median regurgitation decreased from moderate-severe to mild (P < 0.001). During a mean follow-up of 38.3 ± 44.9 months (range 1 month-15 years), there was 1 late death, 16 patients required reoperation on the truncal valve and 1 required a second reoperation. Freedom from reoperation was 91.4 ± 4.8% at 1 year, 55.0 ± 10.4% at 5 and 22.9 ± 12.2% at 10 years. A quadricuspid valve after repair tended to worsen freedom from reoperation (P = 0.15), and tricuspidization tended to improve freedom from reoperation (P = 0.19). Neonatal repair (hazards ratio (HR) 4.1, P = 0.03) and leaflet thinning (HR 22.5, P = 0.002) were independent predictors of reoperation. CONCLUSIONS: Valve repair for truncal valve regurgitation is feasible, with good results. Surgical creation of a tricuspid truncal valve seems to provide the best outcomes in this challenging population.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 04/2013; DOI:10.1093/ejcts/ezt213 · 2.40 Impact Factor
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    ABSTRACT: Congenital quadricuspid aortic valve is a rare cardiac anomaly. More than half of the patients with this abnormality will develop aortic insufficiency in adulthood. It is vital that patients with quadricuspid aortic valve who present with progressive aortic regurgitation undergo valve replacement or repair at appropriate time. Here, we present two cases of quadricuspid aortic valve. We first describe a 58-year-old man who had mitral regurgitation and ascending aorta dilatation with quadricuspid aortic valve. He underwent aortic valve replacement and mitral valve plasty and recovered well. The second patient is a 20-year-old asymptomatic boy who has been closely followed up and has not received any surgical treatment.
    Journal of Cardiothoracic Surgery 04/2013; 8(1):87. DOI:10.1186/1749-8090-8-87 · 1.02 Impact Factor