大動脈二尖弁および大動脈弁閉鎖不全症に対する形成術の術式

How to Repair the Bicuspid Aortic Valve Accompanying Regurgitation?

大動脈二尖弁（BAV），大動脈弁閉鎖不全症（AR）に対する外科治療は，従来は人工弁置換術（AVR）が主流であった．われわれは1997年より大動脈弁形成術（AVP）を適応し，今日までに30例に行った．その臨床成績について報告する．

We repaired the bicuspid aoric valve （BAV） with aortic regurgitation （AR） by bicuspidization. However, repaired fused cusp does not open full, and shows doming. Between 1997 and 2023 we repaired 30 BAV with AR. Mean Age was 44 （15-79） years old. Male gender was 26/30. Between 1997 and 2017, we repaired by triangular resection and cusp suspension or central plication and the commissural positions remained as it was, in 17 cases. Between 2018 and 2023, we repaired by triangular resection and aortic root remodeling to make the commissure angle 180 degree in 13 cases. One patient died because of compression occlusion of left main trunk by Schaefer’s annulplasty suture post-operatively. Postoperative aortic valve pressure gradient was 12.2±5.4 mmHg in natural commissure position group, 14.7±6.8 mmHg in the 180 degree commissure position group （p＝0.37）. And in the 180 degree commissure position group, the fused cusp did not show doming. In the 180 degree commissure position group, the fused cusp did not show doming. However, trans aortic valve pressure gradient did not decrease. On the other hand, in the natural commissure group, the fused cusp showed doming. However, the valves well functioned up to 25 years without aortic stenosis.