ABSTRACT 95

AN ALTERNATIVE TECHNIQUE FOR SEMILUNAR VALVE RECONSTRUCTION WITH A PRE-CUT AUTOLOGOUS PERICARDIUM USING A DEDICATED MOULD

*Sanjeev D.M., *Lim Hou-sen, *Yeo Joon Hock, **Eugene Sim, ***Carlos MG Duran
*Nanyang Technological University Singapore, **National University Hospital, Singapore, ***International Heart Institute of Montana, USA

Abstract:  The reconstruction of aortic valve using autologous pericardium is a good alternative for the treatment of aortic valve disease in selected group of patients.  The autologous pericardium is harvested and cut in tricuspid form using dedicated mould.  As already described by Carlos Duran, this precut trileaflet pericardium is anchored by 5 stitches at base and commissural posts of the native leaflet margin.  The pericardium is sutured starting at the center of base and continued upwards on both sides.  This suturing is done from aortic side while the three leaflets are held in closed position.  In this technique, narrow operating space and need for constant handling of the pericardium, are the main difficulties.

To find simpler and reproducible surgical technique, wet lab exercise was done and various modifications were tried out on porcine heart.  In this new technique the tricuspid pericardium, having 3 cusps together is held in open position.  The holding of pericardium in open position while suturing is the main deviation from earlier described technique.  When the pericardium is deposited in open position in the aortic root, the new cusps lie-abed with the concavity of the sinuses.  This keeps the pericardial edge and the cut edge leaflet aligned with each other, which allows proportionate suturing avoiding any folds.

This paper describes in detail steps of this technique of reconstruction of semilunar valve.  We have found this technique simpler and easily reproducible in the laboratory especially with the smaller aortic roots.