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J Thorac Cardiovasc Surg 2004;127:1602-1607
© 2004 The American Association for Thoracic Surgery
Surgery for acquired cardiovascular disease |
a Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden
b Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital Linköping, Linköping, Sweden
c Department of Medicine, University of California San Francisco, San Francisco, Calif, USA
This work was presented in part at the 52nd Annual Scientific Session of the American College of Cardiology, Chicago, Ill, March 30–April 2, 2003.
Received for publication July 16, 2003; revisions received September 29, 2003; accepted for publication October 6, 2003.
* Address for reprints: John-Peder Escobar Kvitting, MD, Department of Clinical Physiology, Linköping University Hospital, SE-581 85 Linköping, Sweden
johkv{at}imv.liu.se
OBJECTIVE: Sparing the aortic valve has become a surgical option for patients who require repair of aortic root ectasia and have normal valve leaflets. Surgical approaches to valve sparing differ with regard to preservation of the native sinuses of Valsalva. The role of the sinuses and the importance of maintaining them remain controversial.
METHODS: By using a time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging technique, aortic root and aortic blood velocity data were acquired from 2 patients with Marfan syndrome 6 months after aortic valve–sparing surgery with straight Dacron grafts and contrasted with data from 6 normal volunteers.
RESULTS: In normal aortas vortical blood flow became apparent in the individual sinuses after peak systole. The vortices filled the available space behind the valve leaflets and persisted until diastole, expanding and moving inward during aortic valve closure. In contrast, no vortices were observed in the postoperative patients with Marfan syndrome with negligible sinuses.
CONCLUSIONS: Changes in supravalvular flow accompany loss of sinus architecture. Whether the presence, size, and velocity of supravalvular vortices affects the function or durability of the preserved aortic valve remains to be studied.
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