Fixation of aortic ball valve prosthesis (Starr-Edwards).

The technique of fixation of a ball valve prosthesis in the area of the non-coronary cusp by bringing the sutures from the collar of the prosthesis out through the wall of the aorta and tying them over strips of dacron has been discussed by Starr, Edwards, McCord, and Griswold (1963), and advocated by Effler, Groves, and Favaloro (1964). We have never in our first 100 operated cases seen a leak in the area of the non-coronary cusp when using internal fixation through the base of the noncoronary cusp. On the other hand, a weak area seems to exist in the right and left coronary cusps close to the commissure between these two cusps, where we have encountered leakage at the side of the prosthesis in three non-infected and nine infected cases. The aim of this paper is to report the different anatomy found at the base of the different cusps in the root of the aorta with special reference to the fixation of the ball valve prosthesis.