A new ultrasonic process for a renewal of aortic valve decalcification
© Aubert et al; licensee BioMed Central Ltd. 2006
Received: 21 October 2005
Accepted: 05 January 2006
Published: 05 January 2006
Aortic valve decalcification by ultrasound was given up. We evaluated a new ultrasound microhandpiece (Dissectron Penstyle®) to rehabilitate this alternative treatment.
We used under magnifying lenses the ultrasound microhandpiece to decalcify 30 explanted aortic valves. In the cases with embedded calcifications the thin top of the probe could be introduced into the thickness of the leaflet preserving covering layers.
The leaflets were totally decalcified and flexible, and surrounding structures were preserved as assessed by histological examination.
This new approach of ultrasonic aortic valve decalcification gives good in vitro results which allow to consider a clinical evaluation of this procedure.
The aortic valve debridement by ultrasound in degenerative-calcific aortic stenosis appeared to be an alternative treatment for severe calcified aortic stenosis , but was given up because of the high incidence of restenosis and aortic regurgitation [2, 3]. The aim of this study was to rehabilitate aortic valve decalcification by a new probe: the microhandpiece Dissectron Penstyle®. This probe is more handy and more precise than the previous ones. Therefore the reintroduction of valve decalcification by ultrasound is envisageable.
The penstyle handpiece was totally adapted to decalcify aortic valves quickly, with comfort and precision. Although the initial results of the ultrasound decalcification with the previous probes in aortic stenosis were impressive [4, 5] two principal problems were observed: early occurrence of aortic insufficiency and significant incidence of restenosis [2, 3]. Aortic insufficiency was caused by leaflet retraction and the loss of central coaptation thought to be secondary to the healing response . The aortic restenosis was caused by the accumulation of calcium in the remaining fibrillar structure . The excursion of our tip was 110 μm comparatively to the 154 μm excursion of the Cavitron® used by McBride . As the Penstyle® handpiece decalcifies in better conditions than those previously described , with a lower level of mechanical energy, we expected a decreased healing response and consequently a decreased occurrence of aortic insufficiency. There is not any biological effects of our ultrasounds on the normal tissue, therefore we can use our probe safely in a therapeutic approach. The 1.54 mm end diameter of the Penstyle® was extremely precise to decalcify, rendering subsequent damaging of the normal valvular tissue around the calcium limited. The thin top of the probe allowed decalcification within the thickness of the leaflets without destroying the covering layers. The use of magnifying lenses facilitated an accurate procedure. This new approach of decalcification damages the valve as little as possible, so we hope to decrease the risk of early recalcification of the remaining valve. The ultimate test is the longevity of the improved flexibility and function in the patient, so we plan a clinical trial in patients to verify these two parameters. Lastly, we must distinguish two groups: calcific lumps on the aortic surface of the cusps favourable for ultrasound decalcification and embedded calcifications requiring an indispensable complementary treatment of the remaining cavities predisposing to early recalcification. The proposed indication for this new approach is a coronary bypass grafting associated with a stenosis of the aortic valve, when we hesitate to replace the valve. The expected advantage is to avoid a further operation to replace the aortic valve, with all the risks of a redo-operation.
This new approach of ultrasonic aortic valve decalcification was efficient to decalcify all the valves whatever the degree of calcification. Calcific lumps on the aortic surface of the cusps are favourable for this treatment. The mainly pitfall of our technique is to avoid to decalcify embedded calcifications. Even if it is possible to decalcify this sort of calcification, the remaining cavity will be recalcified very quickly. Only a clinical evaluation of this procedure will demonstrate a decreased risk of both recalcification and secondary aortic regurgitation.
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