The evaluation in the valve sparing aortic root reconstruetion, with the cardio vascnlar endoscopy

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1.The relationship of the sinotubular junction (STJ) with aortic regurgitaion (AR)(1) Experimental methodUsing mongrel dogs, the beating heart models were made with perfusion through the aortic root and left atrium with the Tyrode's solution. A six sutures were placed in each commissure and each sinus of Valsalva at the level of STJ.By restracting the sutures outwaeds, delatation of aortic root was simulated. While changing retraction sites, direct images of valve coaptation were recorded with endoscope. Additionally, the strain of the sutures were changed by the gravity.(2) ResultWith the increase on the strain of the sutures, the opening of the aortic valve was exaggerated when either all sutures or the commissures was retracted. In cases of the drawing only three sinuses of Valsalva, the coaptation of the aortic valve was kept uninterrupted. This study validated that the dilatation of STJ cause AR.2.The behavior of the aortic valve under remodeling procedure(1) Experimental methodThe beating heart model was made with same method as 1-(1). Using the cardeac endoscopy and high speed video (200frames/second), the behavior of the aortic valve was investigated under noumal condition (Group 1) and the aortic root reconstruction with remodeling procedure (Group 2)Experimental resultThe pattern of the behavior of the aortic valve was almost equal between Group 1 and 2. With Group 2, the maximum opening of the aortic valve was recorded at the time of maximum aortic pressure. It was concluded that the aortic root reconstruction with remodeling procedure was valuable technique in preserving the aortic valve function.3.Clinical experimentsTo date, seven aortic root reconstructions preserving native valve were perfoumad. In six cases, the evaluation of aortic valve was performaed with endoscopy. Cardiec endoscopy was useful technique in evaluation of the etiology of the valeve imcopetence, selection of the procedure and the result of the plasty.