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J Thorac Cardiovasc Surg 2004;127:897
© 2004 The American Association for Thoracic Surgery

Letter to the editor

Reply to the Editor

Gianclaudio Mecozzi, MD, Stefano Pratali, MD, Uberto Bortolotti, MD

Division of Cardiac Surgery, Cardio Thoracic Department, University of Pisa Medical School, Pisa , Italy

Reply to the Editor:

We appreciate the comments by Dr Turatel to our article on a case of quadricuspid aortic valve stenosis recently published in the Journal.1 He reminds us of the importance of other intracardiac anomalies that are frequently associated with this malformation and that must be recognized when planning an operation to avoid potentially serious complications. We fully agree that among these anomalies displacement of the coronary ostia might play an important role because in some instances it might require modification of the standard surgical technique of prosthetic valve insertion, particularly when a stentless valve is chosen as aortic valve substitute. This point was stressed in a previous publication on the same subject by our group2 when reporting on a patient with aortic insufficiency caused by a quadricuspid valve, in whom, at operation, the right coronary ostium appeared displaced downward, being very close to the commissure between the right and the accessory cusps. In the present case1 no anomalies of the coronary arteries were found, and because of severe calcification of the ascending aorta, it was decided to simultaneously replace the aortic valve and root with a cryopreserved homograft. We believe that with such technique, which requires adequate mobilization of the coronary buttons, displacement of a coronary ostium, even if present, would not have been a problem.


   References
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  1. Mecozzi G, Pratali S, Milano A, Nardi C, Bortolotti U. Severe quadricuspid aortic valve stenosis after mediastinal irradiation. J Thorac Cardiovasc Surg. 2003;126:1198–1199[Free Full Text]
  2. Bortolotti U, Scioti G, Levantino M, Milano A, Nardi C, Tartarini G. Aortic valve replacement for quadricuspid aortic valve incompetence. J Heart Valve Dis. 1998;7:515–517[Medline]




This Article
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