System Designed by Khalil Fattouch MD PhD University of Palermo Cardiac Surgery Department Aortic valve What we learn from the mitral valve ID: 914460
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Slide1
Aortic Valve Anuluplasty System
Designed by Khalil Fattouch, MD, PhD.
University
of
Palermo
Cardiac
Surgery
Department
Slide2Aortic valve
What we learn from the mitral valve?
Surgeons are not
concerned
about
the valve, but with the Aortic Functional Unit
Aortic anulus Cusps Valsalva sinus Commissures Sinotubular Junction Ascending aorta
Slide3Relationship between
severals Aortic Root Components are important for
normal valve function
AA > STJ (10-15%)
Coaptation high = 0.5-0.8 cmHigh of opened leaflet = 70% of sinus
Slide4Tipo Ia-
STJ Dilation
Slide5Functional
Classification of AR
Tipo
I:
Normal leaflet motion
Tipo
II:Excessive leaflets motionTipo III:Restrictive leaflets motion
Ia –
STJ dilation
Ib
–
dilation
of
valsalva
sinuses
Ic
–
FAA
dilation
Id
–
Perforation
Prolapse
Dissection
Calcification
Cusp fusion
Slide6Lesson from mitral
valve repairAnuluplasty is a fundamental step
in mitral valve repair
:
re-shape the anulus stabilize the repair improve
long term results
Slide7Aortic
AnulusWhat is the true valve
anulus ?
Slide8Commissures
Nadir
Aortic Anulus
Slide9Interleaflet triangles
Basal circumference
Sinutubular ridge
commissures
Functional
Aortic
Anulus
FAA = (
Anatomical
anulus
+ STJ)
Slide10Slide11Ring for aortic
valve repairmust:1. re-shape the functional
aortic anulus
2.
Stabilize
the continuity between the aortic valve annulus and the STJ.
Slide12The second
point of viewInterleaflets Triangles
Are essentials
for
normal
leaflets opening and normal distribuition of stress
Annulus
Slide13Mechanism of Opening:sequence of leaflets opening
Stellate orifice
Small triangle
Triangle
Circular orifice
Slide14From stellate orifice to small triangle
Increase in ventricular pressure through the interleaflet triangle causes an increase of diameter at the commissures (STJ) before the valve opens
Answer to the first paradox: “the valve opens before
the presence of forward flow”
Slide15The second
objective?The ring for aortic valve
repair
must,
Leave
the commissures and the interleaflets triangle free to
move during the cardiac cicle, that is essentialfor a normal leaflets motion and stress distribuition
Slide16Today
, what we do in aortic valve repair?Subcommissures
plasty
Slide17Our
idea,
to
re-shape the functional
aortic anulus and preserve aortic leaflets motion
Re-shape the STJRe-shape the anatomical anulus
Slide18From
inside LV
outflow
tract
From outside the aorta
Slide19a
b
Suture
Technique
Leave
free the
interleaflets triangles
Slide20Slide21Re-shape
the sinotubular junction
Applied outside
to the aorta at the
level
of the STJ and sutured to the aorta with the same suture line
when we close the aortotomy using 4-0 prolene. The 3 crown were sutured at the level of commissures and fixed to
the internal ring using
the same ticron
U-stitch
used
previously
.
Slide22The D
shape
of
the
annulus avoid blood turbolence under the aortic valve Flexible zoneFree from suture
Slide23Suture
Technique
Slide24Objective
Re-shape and Stabilize the functional aortic annulus
Undersize the anatomical
aortic
annulus
from inside ofLV outflow tract (improve
leaflets coaptation).Leave the interleaflets triangles and commissures free to move that is mandatory for a normal leaflets stress distribuition and
motion (opening).
An external application
of
a ring
may
lead
to
cusps
prolapse
.
Thank
for
……