A New technique for shaping the aortic sinuses and conserving dynamism in the remodelling operation.

BACKGROUND: Preserving dynamism, and recreation of sinuses in the Dacron graft are thought to be important for optimising results of aortic valve conserving operations.

METHODS: We here describe a novel technique which preserves dynamism and recreates the sinotubular junction, as well as tailors 3 sinuses of defined longitudinal and transverse curvatures in a straight Dacron tube, during operation, the technique has been used in 6 patients with varied aortic root pathology. Pre- and post-operative multimodality imaging with computerized image analysis as well as 3D models were performed.

RESULTS: There was no early or midterm death. On discharge, patients were clinically well, with echocardiographic evidence of minimal (in 3 patients) or mild (in 3 patients) aortic regurgitation. Computed tomography and cardiac magnetic resonance imaging (MRI) with extensive image analysis of the aortic root size, shape and function showed partial or complete normalisation of these parameters. This included the shape and dynamism of the aortic annulus and the size and shape of the geometric (effective) orifice. The 4D MRI pattern of flow in the sinuses and ascending aorta showed favourable vortices in the sinuses, right handed helical flow and marked diminution of energy loss in the ascending aorta.

CONCLUSIONS: The novel technique described in this communication is simple, practical, and cost effective as it uses a widely available straight Dacron tube. The technique does not use rigid internal or external support. The early results are encouraging. Larger series followed up for longer periods are required.