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How To Do It

Right Coronary Sinus Fixation Through a Right Ventriculotomy for David's Procedure

^a Department of Cardiovascular Surgery, Hôpital Haut-Lévèque, Bordeaux Heart University Hospital, Bordeaux-Pessac, France
^b Department of Radiology, Hôpital Haut-Lévèque, Bordeaux Heart University Hospital, Bordeaux-Pessac, France
^d Department of Anaesthesiology, Hôpital Haut-Lévèque, Bordeaux Heart University Hospital, Bordeaux-Pessac, France
^c Laboratory of Anatomy, University Victor Segalen, Bordeaux, France

Accepted for publication November 28, 2007.

^_* Address correspondence to Dr Labrousse, Service de Chirurgie Cardio-Vasculaire, Hôpital Haut-Lévèque, Avenue de Magellan, 33 604, Pessac-Cedex, France (Email: louis.labrousse{at}chu-bordeaux.fr).

A key element to the success of aortic valve reimplantation (David's procedure) is the position of the aortic annulus in the Dacron tube (DuPont, Wilmington, DE). The variable level of the right ventricular insertion can cause technical difficulties, especially when the right ventricular insertion occurs above the aortic annulus. To resolve this issue, a technical adjunct is described using a right superior ventriculotomy. This technique allows perfect aortic annulus containment, avoids any rocking motion of the margin of the right coronary cusp, and affords the procedure better long-term durability.