Precise moulded autologous pericardial configurations for aortic cusp reconstruction

Abstract

OBJECTIVES: In order to facilitate surgical repair of complex aortic cusp deformities and restoration of aortic valve competence, new moulds were developed to shape the glutaraldehyde-treated autologous pericardium into precise cusp-like configurations that can be used in aortic cusp reconstruction. METHODS: The new moulds embodied the natural geometry of single aortic cusps, and a series of moulds were made available to correspond with all potential aortic cusp sizes. Aortic valve reconstruction using moulded autologous pericardial cusps was performed in 2 patients (both males, aged 14 and 19 years) with large outlet-type ventricular septal defects, extensive deformation of prolapsed right coronary cusps and severe aortic valve insufficiency. In each patient, the diseased right aortic cusp was excised and was replaced by a moulded autologous pericardial cusp that equalled the size of adjacent undiseased native cusps. RESULTS: Excellent coaptation with adjoining native aortic cusps could be readily observed and intraoperative transoesophageal echocardiography confirmed satisfactory aortic valve repair (aortic insufficiency <1+ and low-transvalvular gradients). Follow-up transthoracic echocardiography confirmed that aortic valve function remained stable in both patients 2 years postoperatively. CONCLUSIONS: Initial clinical experience indicated that constructing geometrically perfect cusp-like configurations was uncomplicated and implantation of the moulded autologous pericardial cusps restored adequate aortic valve competence. We believe that the simplicity and reproducibility of this approach may assist in the dissemination of aortic cusp reconstruction procedures.