| Co-Investigator(Kenkyū-buntansha) |
FURUKAWA Koujirou Saga University, Faculty of Medicine, Instructor, 医学部, 助手 (90264176)
OHTSUBO Satoshi Saga University, Faculty of Medicine, Assistant Professor, 医学部, 講師 (20291528)
OKAZAKI Yukio Saga University, Faculty of Medicine, Assistant Professor, 医学部, 講師 (80203975)
NATSUAKI Masafumi Saga University, Faculty of Medicine, Associate Professor, 医学部, 助教授 (90075557)
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| Budget Amount *help |
¥12,300,000 (Direct Cost: ¥12,300,000)
Fiscal Year 2003: ¥2,200,000 (Direct Cost: ¥2,200,000)
Fiscal Year 2002: ¥3,100,000 (Direct Cost: ¥3,100,000)
Fiscal Year 2001: ¥7,000,000 (Direct Cost: ¥7,000,000)
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| Research Abstract |
Until recently, the best surgical treatment for patients with aortic regurgitation, associated with annuloaortic ectasia or an ascending aortic aneurysm, was replacement, of the aortic root with a composite valved conduit, However, aortic regurgitation with an ascending or aortic root aneurysm is mainly due to 'dilatation of the sinotubular junction, distortion of one or more of the sinuses of Valsalva, annuloaortic ectasia, or a combination of these problems. Currently, aortic root reimplantation and remodeling are performed clinically to preserve the native aortic valve using this rationale. However, the aortic root is a dynamic unit that allows easy opening and closing and shares, stress for the valve leaflets. When the aortic root is replaced with artificial material the normal aortic root condition may be lost, with impaired preserved aortic valve opening and closing characteristics. These movements could have important implications for the durability of the repair and possibly le
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ft ventricular function, and thus long-term results. Although the short-term and long-term outcomes of these operations have been good, which operation yields results that are more physiologic and more durable has not been well established. Comparative studies, including clinical results and indirect observation of opening and closing of the aortic valve using echocardiography, were reported. However, direct observation of valve motions with the two techniques was not performed. Therefore, we observed the behavior of the aortic valve after the remodeling and reimplantation procedures with direct imaging using cardiac endoscopy, and investigated which procedure is more physiologic. In the current clinical situation, the original reimplantation procedure, called "David-I", is rarely performed: However, we used the original reimplantation procedure in this study because we wanted to clearly analyze the basic conceptual differences between the remodeling and reimplantation procedures. In the remodeling group, the preserved aortic valve opened and closed flexibly and symmetrically, similar to what was seen in the control group. Also, the free margins of the preserved valve straightened through one cardiac cycle. In contrast, in the reimplantation group, the preserved aortic valve showed buckling and asymmetric motion. the opening and closing behavior of the aortic valve preserved by the reimplantation procedure was impaired. In addition, it was speculated that the remodeling procedure may preserve more physiologic aortic root function compared to the reimplantation " procedure. Less
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