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The Journal of Thoracic and Cardiovascular Surgery, Vol 74, 362-371, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DB Doty, DB Polansky and CB Jenson
Enlargement of the aorta with a diamond-shaped patch of the noncoronary
sinus of Valsalva may not be sufficient in severe cases of supravalvular
aortic stenosis. This traditional reconstruction is asymmetric, and, if the
fibrous supravalvular ring is thick and rigid, the aorta may not open wide
with patch angioplasty, so that aortic obstruction may remain. Also,
because aortic valve function may not be perfect after asymmetric
reconstruction, there may be aortic valve incompetence or obstruction of
coronary ostia by the valve cusps. A new reconstructive operation was
designed and used in eight patients. All survived and are asymptomatic. The
aortoplasty was extended so that the supravalvular ring was incised at two
points in the noncoronary and in the right coronary sinuses of Valsalva.
The area of stenosis was opened wide, and the cusps of the aortic valve
were lengthened, which provided better approximation and function. A
tubular Dacron prosthesis, tailored to reconstruct the aorta, provided a
wide aortic cross- sectional area. This technique of extended aortoplasty
for symmetric reconstruction of the aorta should provide more predictable
relief of aortic obstruction and improved function of the aortic valve.
ARTICLES
Supravalvular aortic stenosis. Repair by extended aortoplasty
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