Aortoscopy to Evaluate Cusp Configuration After Aortic Valvuloplasty
Aortic valve repair is an attractive option for patients with aortic insufficiency, especially in the young. However, it has not yet become widely accepted (see Chap. 9 by Arimura) . Why has aortic valve repair been performed so infrequently in contrast with mitral valve repair? There are some anatomical and technical reasons; however, the lack of direct intraoperative evaluation of aortic regurgitation (AR) after repair may be the greatest reason. Generally, the cusp configuration should be assessed using two or three traction sutures fixed at each commissure with the same tension and in a symmetric direction. This cannot always be realized, however, in the clinical setting. Furthermore, this evaluation technique does not imitate diastolic pressure. Therefore, unexpected AR can occasionally be observed after aortic unclamping even if the repair seems appropriate visually. This could be avoided if we could assess the cusp configuration exactly under the condition of physiological pressure.