Tricuspidization of Quadricuspid Aortic Valve

Department of Cardiac Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia. Electronic address: .
The Annals of thoracic surgery (Impact Factor: 3.85). 04/2013; 95(4):1453-5. DOI: 10.1016/j.athoracsur.2012.08.019
Source: PubMed


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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    • "The predominant clinical findings and management issues in QAV relate to progressive AR with aging due to progressive leaflet fibrosis and progressive failure of leaflet coaptation. The quadricuspid aortic valve is replaced in the majority of patients requiring surgery; only a few cases of in situ surgical repair have been reported [8-10]. Schmidt et al. [11] reported surgical plasty repair via tricuspidization in two cases with two normal sized leaflets and two smaller leaflets using a combination of leaflet fusion, resection of the interposed commissure, and, in one patient, patch augmentation. "
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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.
    Full-text · Article · Feb 2014 · Journal of Cardiothoracic Surgery
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    ABSTRACT: We report a rare case of a quinticuspid aortic valve associated with regurgitation and dilation of the ascending aorta, which was diagnosed and post-surgically followed up by cardiovascular magnetic resonance and dual source computed tomography.
    Full-text · Article · Sep 2009 · Journal of Cardiovascular Magnetic Resonance
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    ABSTRACT: A 52-year-old man was referred to our clinic because of chronic heart failure. A Levine 3/6 diastolic heart murmur was audible at the apex. Chest radiography showed an enlarged left ventricle. Transthoracic echocardiography showed moderately severe aortic regurgitation. Left ventricular end-diastolic/systolic diameter and ejection fraction were 75/59 mm and 41 %, respectively. Preoperative transesophageal 3-dimensional echocardiography revealed a quadricuspid aortic valve whose cusps were of almost equal size. Aortic valve replacement was performed via upper partial sternotomy.
    No preview · Article · Nov 2012 · General Thoracic and Cardiovascular Surgery
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