Aortic Valve Repair

The authors present an aortic valve repair performed for a 34-year-old man with a history of tobacco use and hypertension. He was admitted to the authors’ institution with a diagnosis of bicuspid aortic valve with severe aortic insufficiency and deterioration of the systolic function of the left ventricle. After this diagnosis, the authors decided to operate on him.

A computed tomography angiogram was performed, which revealed the absence of coronary disease. The preoperative transesophageal echocardiogram indicated a left ventricular end-diastolic diameter of 66 mm, end-systole diameter of 59 mm, interventricular septum of 10 mm, and posterior wall of 10 mm. The ejection fraction of the left ventricle was 35%. Bicuspid aortic valve with raphe between the left coronary and right coronary cusps and severe aortic insufficiency were informed. The ascending aorta was normal.

The aortic valve was repaired through a full sternotomy. After the aortotomy, a bicuspid aortic valve type 1 with fusion between the right and left coronary cusps was identified. The raphe was incomplete and presented a marked fibrosis. There was an absence of central coaptation, which is why aortic insufficiency was originated. The authors continued the procedure by shaving the raphe and closing it with separates stitches of polypropylene 6-0. Then, plication of the noncoronary cusp and annuloplasty of the same sinus with a number 23 Hegar dilator and autologous pericardium was made. The intraoperative transesophageal echocardiogram showed the absence of aortic insufficiency and a successful aortic valve repair.

The patient evolved favorably and was extubated six hours later. He remained in the intensive care unit for 24 hours without any inotropic drug requirement and was discharged on the fifth postoperative day.