J Thorac Cardiovasc Surg 2009;137:293-294
© 2009 The American Association for Thoracic Surgery
Discussion
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Dr Hans-H. Sievers
(Lübeck, Germany). First, I must disclose my financial relationship to the companies of Sorin (Italy) and Aesculap (Germany).
Dr El Khoury, I congratulate you on an outstanding study and especially for your great efforts to promote aortic valve reconstruction, which is an appealing operation improving in results and techniques. Nevertheless, some results are suboptimal, and a lot of questions are open. You could nicely demonstrate that a seemingly simple repair-oriented classification system of AI supports the understanding of functional anatomy for standardization of reconstructive techniques. Also, your classification system, which combines surgery and anatomy, is useful to direct the choice of the operative method in general. More details, however, are important for decision making and the success of the operation. Briefly, precise definitions are desirable. Thus my first question is as follows. Your classification type I refers to dilatation of different levels of the root. What exactly do you mean by dilatation? You measured the diameters by echocardiography and intraoperatively, but what are your threshold values for diameters to call it dilatation, which is important for decision making?
Dr El Khoury. Thank you, Dr Sievers. The concept of functional aortic annular dilatation is helpful in determining the surgical techniques for this strategy. When we have functional aortic annular dilatation, we have aortic regurgitation; conversely, when we have aortic regurgitation, I believe we have some kind of functional aortic annular dilatation. Saying that, type Ia and type Ib are the classic aneurysmal dilatation of the aneurysmal descending aorta and the root, and we use the standard measurement . . . [Full Text of this Article]
Copyright © 2009 by The American Association for Thoracic Surgery.
