Imaging techniques in aortic valve and root surgery

Aortic valve sparing surgery for aortic regurgitation and/or aortopathy serves as an alternative to aortic valve and root replacement. One of the advantages of aortic valve sparing surgery over conventional replacement is that there is no need for life-long anticoagulation, which is particularly attractive in young patients who may receive a mechanical prosthesis otherwise. However, successful aortic valve repair requires high expertise. At present, reparability is determined intraoperatively by direct surgical inspection. Preoperative imaging techniques might improve the patient selection for aortic valve repair. The mechanism of aortic regurgitation, aortic valve morphology and calcification and aortic root dimensions are all of importance when aortic valve repair is considered. The primary objective of this thesis is to improve patient selection for valve-sparing aortic root reconstructive surgery using imaging techniques. This thesis can be divided into two parts. The first part focuses on imaging in patients with aortic regurgitation and/or aortopathy to evaluate disease progression and to determine reparability of the aortic valve in surgical patients. The second part describes the effect of aortic valve and root surgery on left ventricular performance and aortic dilation.