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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Edward L. Bove Ralph S. Mosca Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bove, E. L. Articles by Mosca, R. S. Search for Related Content PubMed Articles by Bove, E. L. Articles by Mosca, R. S.

J Thorac Cardiovasc Surg 1995;110:565
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

Morphology of critically stenotic aortic valves

Department of Surgery
Division of Pediatric Cardiovascular Surgery
University of Michigan Medical Center
Ann Arbor, MI 48109

Reply to the Editor:

Dr. Anderson's comments raise the question of the importance of the aortic valve structure in determining the outcome of infants treated for critical aortic stenosis. We did not perform transesophageal echocardiography or intravascular ultrasonography on any of these patients, and because the valves were never visualized we have no data on their structure. In fact, we have found the use of echocardiography in describing these valves to be unrewarding. Many surgeons would agree that even under direct inspection the valves frequently appear as amorphous masses of tissue, with no recognizable commissures. Although the exact morphologic characteristics would be of academic interest, the lack of this information does not detract from the data presented. Essentially all patients responded well with satisfactory relief of aortic stenosis and minimal aortic insufficiency, regardless of the technique used (balloon valvuloplasty or transventricular dilation). Assuming that a high prevalence of unicuspid valves would be predicted, as described by Dr. Anderson, this morphologic subtype was likely represented in our group as well. However, there appears to be no significant difference in outcome. It is likely that knowledge of the exact morphologic characteristics of the valves is more important when an open surgical valvotomy is performed.

In describing the mechanisms of relief of stenosis in unicuspid valves, McKay and colleagues ¹ state that tissue above the apex of the interleaflet triangle of the aortic valve is "probably" the strongest part of the leaflet. They then imply that blunt dilation would tend to split the leaflet opposite this point, or through the right coronary cusp. However, this is based on an assumption and is not borne out by our results and the results of others with closed dilation for critical aortic stenosis. It seems logical to us that even a unicuspid valve should have a point of attachment along which it can be opened.

Our patients with critical aortic stenosis responded well as a group. We believe that a closed valvotomy, done properly by either technique described in our manuscript, is effective and reproducible regardless of the morphologic characteristics of the valve.

References

1. McKay R, Smith A, Leung MP, Arnold R, Anderson RH. Morphology of the ventriculoarterial junction in critical aortic stenosis. J THORAC CARDIOVASC SURG 1992;104:434-42.[Abstract]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Edward L. Bove Ralph S. Mosca Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bove, E. L. Articles by Mosca, R. S. Search for Related Content PubMed Articles by Bove, E. L. Articles by Mosca, R. S.