Valvuloplasty by Polytetrafluorethylene Leaflet Extensions for Bicuspid Aortic Valve in a 17-Year-Old Patient

The lack of an ideal valve substitute in the congenitally affected aortic valve has raised the interest in aortic valvuloplasty by leaflet extensions. Several techniques using native or xenopericardium have been described for aortic valve repair, however, the ideal material for leaflet extensions still remains controversial.

In our presentation we show a video of aortic valve repair by leaflet extensions using 0.1 mm polytetrafluorethylene (PTFE) patches. The view is from the patient's head. The bicuspid aortic valve was incised into a tri-leaflet configuration. After excision of thickened edges and shaving of leaflets, all leaflets were extended using rectangular PTFE patches. The length of the free edge of the leaflets was measured using a silk tie. The height of the leaflet extension was determined by measuring the depth of the native left coronary leaflet. Based on these 2 measurements, rectangular 0.1 mm PTFE extensions (Preclude® membrane, W.L. Gore & Assoc., Flagstaff, AZ) were sewn to the free edge of each cusp by 6.0 polypropylene sutures. The new comissures were then created by sewing each of the two leaflets and aortic wall together, upwards toward the new sinotubular junction.

The patient was discharged home with a trace aortic insufficiency and no gradient across the valve.

Based on our limited experience we consider the use of PTFE leaflet extensions as an effective and reproducible technique for aortic valve reconstruction in congenital valvular disease. Long- term follow-up is necessary to assess the durability of this type of repair.

Disclaimer

The video contains an off-label use of a PTFE pericardial membrane.