Aortic valve cusp prolapse before and after valve-sparing aortic root replacement

Correspondence to Professor Marek A Deja, Department of Cardiac Surgery, Medical University of Silesia, Katowice 40-035, Poland; mdeja@sum.edu.pl Composite aortic valve-root conduit replacement has been the mainstay and a ‘gold standard’ of aortic root aneurysm surgery for the last half century. The latter remains the most difficult to repair and yields the least favourable results.4 In the classic paper, Boodhwani et al found that the direction of regurgitant jet on preoperative transoesophageal echocardiography was 92% sensitive and 96% specific for aortic cusp prolapse.5 To complicate things further, surgeons have found that durability of aortic valve-sparing procedures depended on the position of cusps in diastole in aortic root. Interestingly, it has been shown that the results improve with increased number of cusp manipulations.7 Ehrlich et al from Saarland University Medical Centre report their analysis of aortic cusp abnormalities in patients with trileaflet aortic valve and root aneurysm.8 They describe intraoperative findings in 582 patients who underwent aortic root repair for aortic regurgitation or aneurysm. J Thorac Cardiovasc Surg 1992; 103: 617–22. doi:10.1016/S0022-5223(19)34942-6 http://www.ncbi.nlm.nih.gov/pubmed/1532219 3 Vahanian A, Beyersdorf F, Praz F. ESC/EACTS guidelines for the management of valvular heart disease developed by the task force for the management of valvular heart disease of the European Society of cardiology (ESC) and the European association for Cardio-Thoracic surgery (EACTS).