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Aortic allograft implantation techniques: pathomorphology and regurgitant jet patterns by Doppler echocardiographic
T P Willems1, L A van Herwerden, M A Taams
1Department of Cardio-Pulmonary Surgery, Thoraxcenter, University Hospital Rotterdam-Dijkzigt and Erasmus University, Rotterdam, The Netherlands.
Background:
The diagnosis of allograft-specific pathology by echocardiography has important consequences for patient counseling and research. This study describes the pathomorphologic findings and color Doppler jet patterns in a consecutive series of patients after allograft placement with either the subcoronary implantation or root replacement technique.
Methods:
From 1987 to July 1996, the subcoronary allograft implantation technique and root replacement technique were used in 82 patients and 70 patients, respectively. These patients comprised the study group.
Results:
The incidence of paravalvular leaks and eccentric regurgitant jets was higher with subcoronary implantation (41%) than with root replacement (11%). Patients with a subcoronary implanted allograft had a higher incidence of eccentric jets.
Conclusions:
These findings support the concept of preservation of valve geometry after root replacement, as allograft-specific pathomorphologic abnormalities and eccentric jets are more common after subcoronary implantation of allografts. Learning effects, however, cannot be excluded as the cause of these abnormalities.