Aortic valve repair for isolated right coronary leaflet prolapseCentral MessagePerspective
Objectives: Isolated right coronary leaflet prolapse is a common cause of nonaneurysmal aortic insufficiency, but can rarely occur in patients with proximal aortic aneurysms. Standardized techniques for routine autologous repair of this disorder are presented. Methods: Most aortic valve leaflet prol...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250722001468 |
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| author | Arnar Geirsson, MD Clarence H. Owen, MD Robert S. Binford, MD Rochus K. Voeller, MD Christopher R. Burke, MD Jeffrey D. McNeil, MD Lawrence M. Wei, MD Vinay Badhwar, MD J. Scott Rankin, MD |
| author_facet | Arnar Geirsson, MD Clarence H. Owen, MD Robert S. Binford, MD Rochus K. Voeller, MD Christopher R. Burke, MD Jeffrey D. McNeil, MD Lawrence M. Wei, MD Vinay Badhwar, MD J. Scott Rankin, MD |
| author_sort | Arnar Geirsson, MD |
| collection | DOAJ |
| description | Objectives: Isolated right coronary leaflet prolapse is a common cause of nonaneurysmal aortic insufficiency, but can rarely occur in patients with proximal aortic aneurysms. Standardized techniques for routine autologous repair of this disorder are presented. Methods: Most aortic valve leaflet prolapse is isolated to the right coronary leaflet, with hypertension and annular dilatation being contributory. Echocardiographically, a posteriorly eccentric aortic insufficiency jet together with “fracture” of the right leaflet tip are diagnostic. Primary repair includes internal geometric ring annuloplasty to downsize and reshape the annulus, together with central plication of the prolapsing leaflet. Thickened, scarred, or retracted noduli are released using an ultrasonic aspirator. The goal is to achieve equivalent coaptation heights of ≥8 mm for all 3 leaflets. Results: Three videos of 6 cases are provided to illustrate these techniques. In the first, 3 patients are shown with classic isolated right leaflet prolapse. In the second and third videos, alternative pathologies are presented for contrast. Applying the reconstructive approaches of geometric ring annuloplasty, leaflet plication, and ultrasonic nodular release, excellent early and late repair outcomes are obtainable in most patients. Conclusions: The combination of aortic ring annuloplasty, central leaflet plication, and ultrasonic nodular release allows routine and standardized repair of right coronary leaflet prolapse, either isolated or concomitant with aneurysm surgery. |
| format | Article |
| id | doaj-art-c6f6020574e74c6abf599e1a6a1dfdbe |
| institution | DOAJ |
| issn | 2666-2507 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-c6f6020574e74c6abf599e1a6a1dfdbe2025-08-20T03:04:53ZengElsevierJTCVS Techniques2666-25072022-06-0113263010.1016/j.xjtc.2022.02.031Aortic valve repair for isolated right coronary leaflet prolapseCentral MessagePerspectiveArnar Geirsson, MD0Clarence H. Owen, MD1Robert S. Binford, MD2Rochus K. Voeller, MD3Christopher R. Burke, MD4Jeffrey D. McNeil, MD5Lawrence M. Wei, MD6Vinay Badhwar, MD7J. Scott Rankin, MD8Department of Cardiac Surgery, Yale University School of Medicine, New Haven, ConnCone Health, Greensboro, NCOverlake Hospital Medical Center, Belleview, WashDepartment of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MinnDepartment of Cardiac Surgery, University of Washington, Seattle, WashCardiovascular and Thoracic Surgeons of Austin, Austin, TexDepartment of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVaDepartment of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVaDepartment of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa; Address for reprints: J. Scott Rankin, MD, 1 Medical Center Drive, Morgantown, WV 26506.Objectives: Isolated right coronary leaflet prolapse is a common cause of nonaneurysmal aortic insufficiency, but can rarely occur in patients with proximal aortic aneurysms. Standardized techniques for routine autologous repair of this disorder are presented. Methods: Most aortic valve leaflet prolapse is isolated to the right coronary leaflet, with hypertension and annular dilatation being contributory. Echocardiographically, a posteriorly eccentric aortic insufficiency jet together with “fracture” of the right leaflet tip are diagnostic. Primary repair includes internal geometric ring annuloplasty to downsize and reshape the annulus, together with central plication of the prolapsing leaflet. Thickened, scarred, or retracted noduli are released using an ultrasonic aspirator. The goal is to achieve equivalent coaptation heights of ≥8 mm for all 3 leaflets. Results: Three videos of 6 cases are provided to illustrate these techniques. In the first, 3 patients are shown with classic isolated right leaflet prolapse. In the second and third videos, alternative pathologies are presented for contrast. Applying the reconstructive approaches of geometric ring annuloplasty, leaflet plication, and ultrasonic nodular release, excellent early and late repair outcomes are obtainable in most patients. Conclusions: The combination of aortic ring annuloplasty, central leaflet plication, and ultrasonic nodular release allows routine and standardized repair of right coronary leaflet prolapse, either isolated or concomitant with aneurysm surgery.http://www.sciencedirect.com/science/article/pii/S2666250722001468aortic valve insufficiencyaortic valve repairaortic ring annuloplasty |
| spellingShingle | Arnar Geirsson, MD Clarence H. Owen, MD Robert S. Binford, MD Rochus K. Voeller, MD Christopher R. Burke, MD Jeffrey D. McNeil, MD Lawrence M. Wei, MD Vinay Badhwar, MD J. Scott Rankin, MD Aortic valve repair for isolated right coronary leaflet prolapseCentral MessagePerspective JTCVS Techniques aortic valve insufficiency aortic valve repair aortic ring annuloplasty |
| title | Aortic valve repair for isolated right coronary leaflet prolapseCentral MessagePerspective |
| title_full | Aortic valve repair for isolated right coronary leaflet prolapseCentral MessagePerspective |
| title_fullStr | Aortic valve repair for isolated right coronary leaflet prolapseCentral MessagePerspective |
| title_full_unstemmed | Aortic valve repair for isolated right coronary leaflet prolapseCentral MessagePerspective |
| title_short | Aortic valve repair for isolated right coronary leaflet prolapseCentral MessagePerspective |
| title_sort | aortic valve repair for isolated right coronary leaflet prolapsecentral messageperspective |
| topic | aortic valve insufficiency aortic valve repair aortic ring annuloplasty |
| url | http://www.sciencedirect.com/science/article/pii/S2666250722001468 |
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