[Surgery for aortic valve disease with congenital bicuspid aortic valve].

From January 1998 to December 2002, a total of 120 patients underwent aortic valve surgery at our institution. Of these, 26 patients (22%) had congenital bicuspid aortic valve (BAV). Main valvular lesion of BAV was aortic valve stenosis (AS) in 17 and regurgitation (AR) in 9. There was no significant difference in the aortic annular size between BAV and non-BAV cases measured by echocardiography preoperatively [22.8 +/- 2.0 mm versus 22.5 +/- 2.2 mm in AS (NS), and 25.4 +/- 2.4 mm versus 23.4 +/- 2.5 mm in AR (NS)]. At operation, however, supraannular type prosthetic valve was selected more frequently in BAV than in non-BAV because of the difficulty of implanting the proper size prosthetic valve in annular position in BAV [10/25 (40%) in BAV versus 18/91 (20%) in non-BAV (p < 0.05)]. Moreover, ascending aortic dimension in BAV cases was significantly larger than in non-BAV cases [43.7 +/- 7.3 mm versus 39.6 +/- 7.3 mm (p<0.05)]. These features were more prominent in non-raphe BAV cases. These results suggested that operative procedure including prosthetic valve selection needs careful consideration in BAV especially no-raphe patients.

[Epicardial stripping for constrictive pericarditis after mitral valve plasty; report of a case].

A 65-year-old man who underwent mitral valve plasty was readmitted the hospital with severe dyspnea and hypotension 7 months after operation. Results of computerized tomographic scanning and transesophageal echocardiography showed pericardial thickening and left ventricle out flow stenosis due to a constrictive epicardial peel. At the time of reoperation, he underwent both pericardial and epicardial stripping. He demonstrated only limited hemodynamic improvement after pericardial stripping. His hemodynamic status improved markedly after epicardial stripping. His postoperative course was uneventful and no complication was recognized. Epicardial stripping is important in patients with epicardial sclerosis.