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Updated: Sep 7, 2025

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Aortic valve repair for isolated right coronary leaflet prolapse
Arnar Geirsson1, Clarence H Owen2, Robert S Binford3
1Department of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn.
Right coronary leaflet prolapse, a cause of aortic insufficiency, can be effectively repaired using standardized techniques including aortic ring annuloplasty and leaflet plication. These methods ensure excellent outcomes for patients with or without aortic aneurysms.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Aortic Valve Disease
Background:
- Isolated right coronary leaflet prolapse is a frequent cause of nonaneurysmal aortic insufficiency.
- It can occasionally be observed in patients with proximal aortic aneurysms.
Purpose of the Study:
- To present standardized techniques for the autologous repair of isolated right coronary leaflet prolapse.
- To illustrate the application of these techniques in various clinical scenarios.
Main Methods:
- Echocardiography is used to diagnose posteriorly eccentric aortic insufficiency jets and right leaflet tip "fracture".
- Primary repair involves internal geometric ring annuloplasty and central leaflet plication.
- Ultrasonic aspiration is employed to release thickened or scarred noduli, aiming for ≥8 mm leaflet coaptation.
Main Results:
- Three videos demonstrate techniques applied to 6 cases, including classic isolated prolapse and alternative pathologies.
- Excellent early and late repair outcomes were achieved in most patients.
- The described reconstructive approaches proved effective.
Conclusions:
- A combination of aortic ring annuloplasty, central leaflet plication, and ultrasonic nodular release enables routine and standardized repair.
- This approach is suitable for both isolated right coronary leaflet prolapse and cases associated with aneurysm surgery.
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