الفهرس 
Embryology and surgical anatomy of the aortic valveOnly 14 pages are availabe for public view
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Abstract
Introduction: Severe chronic AR should be defined as the degree of backflow across the aortic valve that results in progressive left ventricular dilatation in association with adverse clinical outcome. Aortic regurgitation results from malcoaptation of the aortic leaflets due to abnormalities of the aortic leaflets, their supporting structures (aortic root and annulus), or both. Aim of work: The aim of this prospective study is to correlate the postoperative left ventricular function with the degree of severity of preoperative left ventricular function depending on echocardiographic findings in patients who will undergo aortic valve replacement for chronic aortic regurge. Patients and methods: The study included 50 surgical patients. They were divided into two groups according to the degree of left ventricular dilatation at the end of diastole as assessed by echocardiography: Group I: patients with EDD ≥ 70 mm and Group II: patients with EDD < 70 mm. Patients’ age in the two groups ranged from fourteen to forty five years. The mean age was 25.32± 6.50 years. There are thirty seven men (74%) and thirteen women (26%). The range of body surface area in all patients is from 1.46 m2 to 2.20 m2, the mean body surface area was 1.83±0.16 m2. Results: Twenty patients (40%) were in NYHA class III and IV preoperatively, there were fifteen patients (60%) in group one, five patients (20%) in group II. Only four patients (8%) had chest pain, three in group I (12%) and one patient (4%) in group II. The duration of symptoms ranged from six months to seventeen years with a mean 4.58± 3.29 years. The majority of patients, forty six (92%) were in sinus rhythm preoperatively. The mean ESD in group I was 5.23±0.79 cm, it was 4.26±0.32 cm in group II. The mean EDD in group I was 7.69±0.74 cm, it was 6.52±5.48 cm in group II. There were no significant statistical differences as regard EF and aortic root diameter (P value 0.089 and 0.332 respectively). Median sternotomy was the standard approach in forty seven (94%) patients. Only three patients (12%) from group II were approached through partial upper sternotomy. The cardiopulmonary bypass time in all patients ranged from fifty two to one hundred twenty minutes (mean time 79.9±18.34). Aortic cross clamp time ranged from thirty eight to ninety minutes with a mean 56.9±12.88. There was only one in-hospital mortality (2%), he was young male patient seventeen years old with grade IV dyspnea, EDD 82 mm and ejection fraction was 39%. Conclusions: Surgery is indicated in cases with chronic severe aortic regurge when they are symptomatic or when they develope left ventricular dilatation with left ventricular EDD more than 70 mm. Our study confirmed that increased left ventricular dimensions don’t contraindicate surgery but higher rates of morbidity and mortality are expected.