Repair Of Unicuspid Aortic Valves In Children Using Geometric Ring Annuloplasty
Nicholas D. Andersen, MD1, Andrew J. Lodge, MD1, J. Scott Rankin, MD2, Joseph W. Turek, MD, PhD1.
1Duke University Medical Center, Durham, NC, USA, 2West Virginia University, Morgantown, WV, USA.
Objective: To present our current technique for unicuspid aortic valve repair in children with use of geometric ring annuloplasty. Methods: The patient featured is a 13-year-old boy who presented with symptomatic severe aortic insufficiency (AI) and was found to have a unicuspid aortic valve (right-left and right-non fusion) with leaflet prolapse. The annular dimension was 25 mm. Repair was performed by dividing the right-non fused commissure, followed by placement of a 19 mm sub-annular bicuspid annuloplasty ring, intended to normalize the annular shape and recruit leaflet tissue to the midline. Bicuspidization of the valve was completed by using edge plication sutures to adjust leaflet height and facilitate midline leaflet coaptation without prolapse. Completion echocardiography demonstrated no AI and trivial aortic stenosis (AS). Results: We have used this technique for aortic valve repair in 6 children (ages 12-18) with unicuspid valve morphology and severe AI (n=5) or severe AS (n=1). All 6 patients had trace-mild AI and trace-mild AS at case completion. At a mean follow-up of 6.5 months, 4 patients have </= mild AI, and 2 patients have moderate AI. Mean valve gradients at latest follow-up ranged from 13 - 28 mmHg (average 20 +/- 7 mmHg). Conclusion: Repair of unicuspid aortic valves in children with bicuspidization and geometric ring annuloplasty achieves satisfactory short-term results and may have benefits to alternative aortic valve repair or replacement procedures given the preservation of native leaflet material. Careful follow-up will be required to determine the longevity of these repairs.