[Echocardiography evaluation of operative procedures for rheumatic aortic valvular diseases]

It is well known that in patients with markedly retracted aortic cusps of rheumatic origin, valve replacement is mandatory because valve repair including commissurotomy and slicing often increase the degree of aortic regurgitation. The degree of the induced regurgitation is considered to be dependent on the retraction of aortic cusps. Therefore, the preoperative evaluation of the severity of retraction is necessary when determining the type of operative procedures. The purpose of this study is to investigate the parameters indicating the degree of cusp retraction by two-dimensional echocardiography. The diameter of the aortic root (R) and the depths from the aortic root to the bottom of the Valsalva sinus (S) and the aortic cusp (C) were measured in nine cases with aortic valvular disease, in which four underwent valve repair and five valve replacement. The control consisted of 20 healthy subjects. The results were as follows: The C/R ratio exhibited a significant correlation with the degree of retraction of aortic cusps, and was considered to be a useful parameter for the determination of the type of operative procedures for aortic valvular disease. It was suggested that in cases with the C/R ratio of 0.5 or more, both commissurotomy and slicing of cusps were effective for improvement of valvular function, while in cases with the ratio less than 0.5, only valve replacement was effective. The diameter of the aortic valve ring between the inner echoes of both the anterior and posterior walls measured by echocardiography was correlated well with the result obtained at operation.