Reflections on valve-sparing operations utilizing straight tube versus Valsalva grafts.

muscles (3). Furthermore, the downsized root diameters potentially lead to leaflet redundancy and leaflet folds often requiring surgical adaptation. How much correction of the leaflets in a non-distensible prosthesis is necessary? Together these factors prevent the leaflets from completely aligning and adhering to the wall but do not prevent the intermittent wall contact of the leaflets that was reported as a constant echocardiographic finding after the David operation with a straight tube (4), but not when a sinus was present (5). Magnetic resonance imaging confirmed these results and additionally found malrotated vortices behind the leaflets in a straight tube with unknown sequelae (3). In our experiments also