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Perioperative changes in dynamic aortic root morphology after Yacoub's root remodeling and concomitant aortic annuloplasty

^a Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, 1-2-1 Chuoudori Morioka City, Iwate, Japan
^b Department of Cardiology, Memorial Heart Center, Iwate Medical University, Morioka, Japan

^* Corresponding author. Tel.: +81-19-651-5111; fax: +81-19-624-8384
t-kazui{at}pf6.so-net.ne.jp

We have performed aortic root remodeling concomitant with aortic annuloplasty (subvalvular circular annuloplasty: it tightens the aortic annulus, using Gore-Tex strip (N.L. Gore and Associates, Arizona, USA)) in patients with AAE and AR. We examined morphologic changes in the aortic root during cardiac cycles, using pre- and post-operative echocardiography. Twelve patients were underwent the procedure. Their grade of AR was 3.2±1.0. Five adults with normal aortic roots were studied as controls. The systolic and diastolic radius of each cusp was measured at the annulus, the Valsalva and the STjunction level. The ratio of diastolic radius to systolic radius in the control, pre-operative data and post-operative data was obtained. In the controls, the rate of diameter change during the cardiac cycle was largest at the annulus level (Right coronary cusp (RCC), Left coronary cusp (RCC), Noncoronary cusp (NCC); 1.00±0.2, 1.12±0.1, 1.23±0.2), second largest at Valsalva level (RCC, LCC, NCC; 0.96±0.6, 1.07±0.2, 0.97±0.2), and smallest at the ST junction (RCC, LCC, NCC; 0.95±0.4, 1.03±0.2, 0.93±0.2). Pre-operative data showed that it was largest at the Valsalva level. Post-operative data showed that the rate of change at each level was not significantly different from the control data. All patients were in NYHA class I and the grade of AR was 0.4±0.7 at the latest follow-up. Subvalvular circular annuloplasty did not interfere with annulus motion during the cardiac cycle. Aortic root remodeling and concomitant aortic annuloplasty restored near normal cyclic aortic root motion and morphology on the short-term.

Key Words: Aortic root morphology; Aortic root motion; Aortic root remodeling; Subvalvular circular annuloplasty