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J Thorac Cardiovasc Surg 2005;130:243-244
© 2005 The American Association for Thoracic Surgery

Editorial

Sizing and tailoring the Dacron graft for reimplantation of the aortic valve

Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Received for publication March 16, 2005; accepted for publication April 1, 2005.

^_* Address for reprints: Tirone E. David, MD, Department of Surgery, University of Toronto, 200 Elizabeth St, 13EN219, Toronto, Ontario M5G 2C4, Canada (Email: tirone.david@uhn.on.ca).

The first 20% of the full text of this article appears below.

In this issue of the Journal, Thomas Gleason ¹ describes a new formulation to determine the diameter of the graft to be used for reimplantation of the aortic valve with creation of neoaortic sinuses. All his geometric assumptions are based on anatomic measurements of the normal aortic root. This is a problem because the anatomic components of the aortic valve in patients with aortic root aneurysm are almost invariably abnormal. The aortic annulus in these patients is often enlarged, and the height of the subcommissural triangles tends to be shorter than normal beneath the commissures of the noncoronary cusp. Those two triangles are more obtuse than normal. The aortic cusps are larger than usual and, more important, the free margins of one or more cusps are almost always elongated. The sinuses of Valsalva are aneurysmal, and the sinotubular junction is dilated. The more severe the aortic valve insufficiency, the more abnormal the components of the aortic root are, particularly the aortic cusps. Moreover, even in patients without aortic insufficiency, the anatomic components are abnormal. What makes aortic valve-sparing operations difficult is our inability to identify the abnormalities of the aortic root that need correction. The size and shape of the graft used for correction might be of secondary importance. Obviously, one cannot use one or two . . . [Full Text of this Article]

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New graft formulation and modification of the David reimplantation technique

Thomas G. Gleason
J. Thorac. Cardiovasc. Surg. 2005 130: 601-603. [Extract] [Full Text] [PDF]

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