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Salve GG, Edington AK, Vijayaraghavan A, Betts KS, Ayer JG, Ramakrishnan K, Winlaw DS, Orr Y, Nicholson IA. Technique of coronary button transfer has no impact on neoaortic root size in simple transposition. Semin Thorac Cardiovasc Surg 2022; 35:377-386. [DOI: 10.1053/j.semtcvs.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
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2
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Abeln KB, Schäfers S, Ehrlich T, Federspiel JM, Schäfers HJ. Ross Operation with Autologous External Autograft Stabilization - Long-term Results. Ann Thorac Surg 2021; 114:502-509. [PMID: 34678281 DOI: 10.1016/j.athoracsur.2021.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We have proposed an external stabilization technique to minimize autograft dilatation after the Ross operation. The aim of this study was to analyze autograft function and root dimensions following root replacement with and without external root support. METHODS Between 10/1995 and 02/2021, 185 adult patients (73% male; age 38±9 years) underwent a Ross operation as full-root replacement with (n=136) or without support (n=49). Autograft function and root dimensions were determined echocardiographically. Median follow-up was 3.4[1.13-14.74] years; it was 95% complete. Survival and freedom from reoperation were calculated; changes in autograft root dimensions were analyzed using mixed-effect models. RESULTS Survival (95%) and freedom from autograft reoperation (94%) at 15 years were higher with than without support (p=0.003 or p=0.004). In the first five years, patients with support showed an indexed root size progression of 0.712mm/(year*m)(p=0.003) compared to 1.554mm/(year*m)(p=0.001) without. Progression rates were higher for patients without stabilization (p=0.045). After five years, progression rates were similar in both groups (0.248mm/(year*m)(p<0.001) with persistent difference between the groups. CONCLUSIONS The Ross procedure as full-root replacement is associated with a relevant rate of autograft dilatation and reoperation. The use of external root stabilization may reduce autograft dilatation and is associated with improved survival and durability.
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Affiliation(s)
- Karen B Abeln
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Tristan Ehrlich
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Jan M Federspiel
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
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3
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Moscarelli M, Bonifazi R, Nasso G, Di Bari N, Speziale G. A Modified Technique for Ascending Aorta Replacement With Sinotubular Junction Stabilization. Ann Thorac Surg 2020; 110:e335-e337. [DOI: 10.1016/j.athoracsur.2020.03.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022]
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4
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Grattan M, Prince A, Rumman RK, Morgan C, Petrovic M, Hauck A, Young L, Franco-Cereceda A, Loeys B, Mohamed SA, Dietz H, Mital S, Fan CPS, Manlhiot C, Andelfinger G, Mertens L. Predictors of Bicuspid Aortic Valve–Associated Aortopathy in Childhood. Circ Cardiovasc Imaging 2020; 13:e009717. [DOI: 10.1161/circimaging.119.009717] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Bicuspid aortic valve (BAV) is the most prevalent congenital heart defect affecting 1% to 2% of the population. It is associated with ascending aorta dilatation. Valve morphology, aortic stenosis (AS), and aortic insufficiency (AI) have been proposed as potential risk factors; however, evaluating their role is difficult, as these factors are inherently related. The aim of this study was to determine whether BAV morphology and dysfunction are independent determinants for ascending aorta dilatation in pediatric patients.
Methods:
A multicenter, retrospective, cross-sectional study of pediatric BAV patients followed since 2004 was performed. Imaging data were assessed for BAV morphology, severity of AS and AI, history of coarctation, and aortic dimensions. Associations were determined using multivariable regression analysis. A subset of patients undergoing aortic interventions (balloon dilation or Ross) were assessed longitudinally.
Results:
Data were obtained from 2122 patients (68% male; median age 10.2 years). Fifty percent of patients had ascending aorta dilatation. Right and noncoronary cusp fusion, increasing AS and AI, and older age were independently associated with ascending aorta dilatation. A history of coarctation was associated with less ascending aorta dilatation. In patients with neither AS nor AI, 37% had ascending aorta dilatation (4% severe). No complications related to aortic dilatation occurred in this cohort. Aortic
Z
scores were determined, and a
Z
-score calculator was created for this population.
Conclusions:
In this large pediatric cohort of patients with BAV, valve morphology, AS, and AI are independently associated with ascending aorta dilatation, suggesting that hemodynamic factors influence aortopathy. However, even in BAVs with no AS or AI, there is significant ascending aorta dilatation independent of valve morphology. Interventions that led to changes in degree of AI and AS did not seem to influence change in aortic dimensions. The current BAV cohort can be used as a reference group for expected changes in aortic dimensions during childhood.
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Affiliation(s)
- Michael Grattan
- Department of Paediatrics, LHSC Children’s Hospital, University of Western Ontario, London, Canada (M.G.)
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Andrea Prince
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Canada (A.P., G.A.)
| | - Rawan K. Rumman
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Conall Morgan
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Michele Petrovic
- Division of Cardiology, The Hospital for Sick Children, Toronto, Canada (M.P.)
| | - Amanda Hauck
- Division of Cardiology, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL (A.H., L.Y.)
| | - Luciana Young
- Division of Cardiology, Department of Pediatrics, Ann & Robert Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL (A.H., L.Y.)
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (A.F.-C.)
| | - Bart Loeys
- Center for Medical Genetics, University of Antwerp/Antwerp University Hospital, Belgium (B.L.)
| | - Salah A. Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Germany (S.A.M.)
| | - Harry Dietz
- Medicine, Pediatrics, and Molecular Biology and Genetics, Johns Hopkins University School of Medicine/HHMI, Baltimore, MD (H.D.)
| | - Seema Mital
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Chun-Po Steve Fan
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Cedric Manlhiot
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
| | - Gregor Andelfinger
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Canada (A.P., G.A.)
| | - Luc Mertens
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada (M.G., R.K.R., C.M., S.M., Ch.-P.S.F., C.M., L.M.)
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5
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Michalak KW, Sobczak-Budlewska K, Moll JJ, Szymczyk K, Moll JA, Łubisz M, Moll M. Neoaortic Regurgitation in Patients with Transposition Long Term After an Arterial Switch Operation and Its Relation to the Root Diameters and Surgical Technique Used. Pediatr Cardiol 2020; 41:31-37. [PMID: 31654096 PMCID: PMC6987136 DOI: 10.1007/s00246-019-02217-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/02/2019] [Indexed: 10/26/2022]
Abstract
Neoaortic regurgitation and root dilatation are common findings in patients with transposition after an arterial switch operation. The aim of this study was to describe the relation between neoaortic regurgitation long term after an arterial switch procedure, aortic root diameters, and surgical technique used. We also assessed the agreement of the neoaortic regurgitation grade and root diameters in different imaging modalities. For this retrospective study, we qualified 56 consecutive patients who, according to our institutional protocol, had a routine postoperative evaluation of more than 16 years with multimodality imaging studies. Neoaortic regurgitation was assessed by both transthoracic echocardiography and magnetic resonance imaging, and the root diameters obtained by echocardiography and tomography were compared to the reference values and associated with the presence of neoaortic insufficiency. Neoaortic insufficiency was present in 75% of examined patients; the vast majority of them had trace or mild regurgitation, and its qualitative evaluation was significantly different between echocardiography and magnetic resonance imaging. In our study group, the neoaortic valve and aortic sinus were larger in relation to the normal values, and they were significantly correlated with the presence of neoaortic insufficiency, but not with the surgical technique used. Values obtained by echocardiography and tomography correlated well but were significantly different. Transthoracic echocardiography has a tendency to overestimate the severity of regurgitation compared to magnetic resonance imaging. Neoaortic valve and sinus dilatation are significantly correlated with valve insufficiency, but in most cases of root dilatation, the valve remains competent.
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Affiliation(s)
- Krzysztof W. Michalak
- grid.415071.60000 0004 0575 4012Department of Cardiology, Research Institute, Polish Mother’s Memorial Hospital, ul. Rzgowska 281/289, 93-338 Lodz, Poland
| | - Katarzyna Sobczak-Budlewska
- grid.415071.60000 0004 0575 4012Department of Cardiology, Research Institute, Polish Mother’s Memorial Hospital, ul. Rzgowska 281/289, 93-338 Lodz, Poland
| | - Jacek J. Moll
- grid.415071.60000 0004 0575 4012Department of Cardiac Surgery, Polish Mother’s Memorial Hospital, Lodz, Poland
| | - Konrad Szymczyk
- grid.8267.b0000 0001 2165 3025Department of Diagnostic Imaging, Medical University of Lodz, Lodz, Poland
| | - Jadwiga A. Moll
- grid.415071.60000 0004 0575 4012Department of Cardiology, Research Institute, Polish Mother’s Memorial Hospital, ul. Rzgowska 281/289, 93-338 Lodz, Poland
| | - Monika Łubisz
- grid.415071.60000 0004 0575 4012Department of Cardiology, Research Institute, Polish Mother’s Memorial Hospital, ul. Rzgowska 281/289, 93-338 Lodz, Poland
| | - Maciej Moll
- grid.415071.60000 0004 0575 4012Department of Cardiac Surgery, Polish Mother’s Memorial Hospital, Lodz, Poland
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6
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Hosono M, Kawazoe K, Kuwauchi S, Taniguchi N, Yasumoto H, Minato N. Commissure enhancement technique in aortic valve repair. Gen Thorac Cardiovasc Surg 2019; 68:408-410. [PMID: 31679133 DOI: 10.1007/s11748-019-01237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
Sinotubular junction enlargement is one of possible causes of aortic valve regurgitation. However, there is no appropriate technique for sinotubular junction diameter reduction in aortic valve repair in a patient without disease of the ascending aorta or sinus of Valsalva. Herein, we report a simple commissure enhancement technique comprising the placement a horizontal mattress suture buttressed with felt at the sinotubular junction level in the commissure area. This technique results in the relocation of the commissure to the inner side, and a reduction in the diameter of the sinotubular junction.
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Affiliation(s)
- Mitsuharu Hosono
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Kohei Kawazoe
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Shintaro Kuwauchi
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Naoki Taniguchi
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Hiroshi Yasumoto
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Naoki Minato
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, 573-1010, Japan
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7
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Sohmer B, Jafar R, Patel P, Chamberland MÈ, Labrosse MR, Boodhwani M. Aortic Valve Cusp Coaptation Surface Area Using 3-Dimensional Transesophageal Echocardiography Correlates with Severity of Aortic Valve Insufficiency. J Cardiothorac Vasc Anesth 2017; 32:344-351. [PMID: 29128482 DOI: 10.1053/j.jvca.2017.08.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to test both in humans and using finite element (FE) aortic valve (AV) models whether the coaptation surface area (CoapSA) correlates with aortic insufficiency (AI) severity due to dilated aortic roots to determine the validity and utility of 3-dimensional transesophageal echocardiographic-measured CoapSA. DESIGN Two-pronged, clinical and computational approach. SETTING Single university hospital. PARTICIPANTS The study comprised 10 patients with known AI and 98 FE simulations of increasingly dilated human aortic roots. INTERVENTIONS The CoapSA was calculated using intraoperative 3-dimensional transesophageal echocardiography data of patients with isolated AI and compared with established quantifiers of AI. In addition, the CoapSA and effective regurgitant orifice area (EROA) were determined using FE simulations. MEASUREMENTS AND MAIN RESULTS In the 10 AI patients, regurgitant fraction (RF) increased with EROA (R2 = 0.77, p = 0.0008); CoapSA decreased with RF (R2 = 0.72, p = 0.0020); CoapSA decreased with EROA (R2 = 0.71, p = 0.0021); and normalized CoapSA (CoapSA / [Ventriculo-Aortic Junction × Sinotubular Junction]) decreased with EROA (R2 = 0.60, p = 0.0088). In the 98 FE simulations, normalized CoapSA decreased with EROA (R2 = 0.50, p = 0.0001). CONCLUSIONS In both human and FE AV models, CoapSA was observed to be inversely correlated with AI severity, EROA, and RF, thereby supporting the validity and utility of 3D TEE-measured CoapSA. A clinical implication is the expectation that high values of CoapSA, measured intraoperatively after AV repairs, would correlate with better long-term outcomes of those repairs.
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Affiliation(s)
- Benjamin Sohmer
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Reza Jafar
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Prakash Patel
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Marie-Ève Chamberland
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michel R Labrosse
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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8
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Mourino-Alvarez L, Baldan-Martin M, Gonzalez-Calero L, Martinez-Laborde C, Sastre-Oliva T, Moreno-Luna R, Lopez-Almodovar LF, Sanchez PL, Fernandez-Aviles F, Vivanco F, Padial LR, Akerstrom F, Alvarez-Llamas G, de la Cuesta F, Barderas MG. Patients with calcific aortic stenosis exhibit systemic molecular evidence of ischemia, enhanced coagulation, oxidative stress and impaired cholesterol transport. Int J Cardiol 2016; 225:99-106. [PMID: 27716559 DOI: 10.1016/j.ijcard.2016.09.089] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The most common valve diseases are calcific aortic stenosis (AS) and aortic regurgitation (AR). The former is characterized by thickening of valve leaflets followed by progressive calcification, which produces progressive aortic valve (AV) narrowing, increased pressure afterload on the left ventricle (LV) and subsequent LV hypertrophy. On the other hand, AR is due to malcoaptation of the valve leaflets with resultant diastolic reflux of blood from aorta back to the LV producing volume and pressure overload and progressive LV dilatation. In order to isolate the molecular mechanisms taking place during AS, we have used an integrated "-omic" approach to compare plasma samples from AS and from AR patients used as controls. The final purpose of this work is to find molecular changes in response to the calcification of the AV, diminishing the effects of the AV dysfunction. METHODS AND RESULTS Using two-dimensional difference gel electrophoresis (2D-DIGE) and gas chromatography coupled to mass spectrometry (GC-MS) in a cohort of 6 subjects, we have found differences in 24 protein spots and 19 metabolites, respectively. Among them, 7 proteins and 3 metabolites have been verificated by orthogonal techniques (SRM or turbidimetry): fibrinogen beta and gamma chain, vitronectin, apolipoprotein C-II, antithrombin III, haptoglobin, succinic acid, pyroglutamic acid and alanine. Classification according to their main function showed alterations related to coagulation, inflammation, oxidative stress, response to ischemia and lipid metabolism, defining 4 different molecular panels that characterize AS with high specificity and sensitivity. CONCLUSION These results may facilitate management of these patients by making faster diagnostics of the disease and better understand these pathways for regulating its progression.
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Affiliation(s)
- Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Montserrat Baldan-Martin
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | | | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Rafael Moreno-Luna
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | - Pedro L Sanchez
- Department of Cardiology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Fernando Vivanco
- Department of Immunology, IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Luis R Padial
- Department of Cardiology, Hospital Virgen de la Salud, SESCAM, Toledo, Spain
| | - Finn Akerstrom
- Department of Cardiology, Hospital Virgen de la Salud, SESCAM, Toledo, Spain
| | | | - Fernando de la Cuesta
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.
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Kirsch EWM, Radu NC, Allaire E, Loisance DY. Pathobiology of Idiopathic Ascending Aortic Aneurysms. Asian Cardiovasc Thorac Ann 2016; 14:254-60. [PMID: 16714709 DOI: 10.1177/021849230601400320] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The majority of ascending aortic aneurysms cannot be related to any specific etiology and should be qualified as idiopathic. The pathobiology of ascending aortic aneurysms remains incompletely understood. Data from direct study are still scarce and often limited because of patient heterogenicity. Currently available information suggests that destructive remodeling of the aortic wall, inflammation and angiogenesis, biomechanical wall stress, and molecular genetics are relevant mechanisms of idiopathic ascending aortic aneurysm formation and progression. Further understanding of these mechanisms will likely provide novel diagnostic, prognostic, and therapeutical tools for the clinician.
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Affiliation(s)
- E W Matthias Kirsch
- Department of Cardiothoracic Surgery, Hospital Henri Mondor, 51 Avenue Mal de Lattre de Tassigny, Créteil Cedex 94 000, France.
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10
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Holtz J, Teuteberg J. Management of aortic insufficiency in the continuous flow left ventricular assist device population. Curr Heart Fail Rep 2014; 11:103-10. [PMID: 24193452 DOI: 10.1007/s11897-013-0172-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With the current generation of continuous-flow (CF) left ventricular assist devices (LVADs), patients are able to be supported for longer periods of time. As a result, there has been increasing focus on long-term complications from prolonged mechanical circulatory support, such as acquired aortic insufficiency (AI). In the presence of an LVAD, AI leads to a blind circulatory loop, with a portion of LVAD output regurgitating through the aortic valve (AV) into the left ventricle and back again through the device, limiting effective forward flow and ultimately leading to organ malperfusion and increased left ventricular diastolic pressures. The AV also experiences abnormal biomechanics as a result of limited valve opening in the presence of a CF LVAD. Increased shear stress, elevated transvalvular pressure gradients, and decreased valve open time all contribute to acquired AI. The prognosis of moderate to severe AI in LVAD patients is generally poor and leads to a higher rate of AV replacement and potentially reduced survival. However, there are no evidence-based guidelines for management of this challenging population. In severe AI, experts generally advocate AV replacement or repair, while lesser degrees of AI can be managed medically and/or with adjustments in pump parameters.
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Affiliation(s)
- Jonathan Holtz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, S-553 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA,
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11
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Gallego P, Chaparro M, Méndez I, Castro A, Martínez-Torres MÁ, Gómez-Domínguez R. Valoración ecocardiográfica de la anatomía funcional de la insuficiencia aórtica durante la cirugía de reparación valvular. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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12
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The role of transesophageal echocardiography in aortic valve preserving procedures. Indian Heart J 2014; 66:327-33. [PMID: 24973839 DOI: 10.1016/j.ihj.2014.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 05/07/2014] [Indexed: 11/21/2022] Open
Abstract
In selected cases of aortic regurgitation, aortic valve (AV) repair and AV sparing root reconstruction viable alternatives to aortic valve replacement. Repair and preservation of the native valve avoids the use of long-term anticoagulation, lowers the incidence of subsequent thromboembolic events and reduces the risk of endocarditis. Additionally repair has a low operative mortality with reasonable mid-term durability. The success and longer term durability of AVPP has improved with surgical experience. An understanding of the mechanism of the AR is integral to determining feasibility and success of an AVPP. Assessment of AV morphology, anatomy of the functional aortic annulus (FAA) and the aortic root with transesophageal echocardiography (TEE) improves the understanding of the mechanisms of AR. Pre- and intra-operative TEE plays a pivotal role in guiding case selection, surgical planning, and in evaluating procedural success. Post-operative transthoracic echocardiography is useful to determine long-term success and monitor for recurrence of AR.
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13
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Mangini A, Contino M, Romagnoni C, Lemma M, Gelpi G, Vanelli P, Colombo S, Antona C. Aortic valve repair: a ten-year single-centre experience. Interact Cardiovasc Thorac Surg 2014; 19:28-35. [DOI: 10.1093/icvts/ivu058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Deo SV, Burkhart HM, Dearani JA, Schaff HV. Supravalvar aortic stenosis: current surgical approaches and outcomes. Expert Rev Cardiovasc Ther 2014; 11:879-90. [PMID: 23895031 DOI: 10.1586/14779072.2013.811967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Supravalvar aortic stenosis (SVAS) is a congenital anomaly characterized by a discrete or diffuse narrowing of the ascending aorta. It may also be associated with right-ventricular outflow tract obstruction, aortic valve pathology and coronary ostial stenosis. While present in both familial and sporadic forms, it demonstrates a strong association with William-Beuren syndrome, both being anomalies associated with defects in the elastin gene. In this article, the authors have discussed the etiology, morphology, clinical presentation and genetic basis of SVAS. Various surgical approaches, both conventional and recent, have been discussed and demonstrated with the aid of diagrams. Single-, two- and three-sinus methods have been presented, along with a comparative analysis of early results, associated procedures, late mortality and reoperation. In conclusion, the authors have described their institutional experience of more than 40 years in the surgical management of SVAS.
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Affiliation(s)
- Salil V Deo
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MI 55905, USA
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15
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Partial aortic root remodeling in case of ascending aortic aneurysms. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:264-8. [PMID: 24126322 DOI: 10.1097/imi.0b013e3182a754b6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In degenerative ascending aortic aneurysms (AAAs), the pathological process may extend into the aortic root, causing aortic regurgitation (AR). As often one or two sinuses are involved, ascending aorta replacement should be associated with selected sinus replacement. METHODS Thirty patients (21 men and 9 women; mean ± SD age, 70.0 ± 10.4) were operated on for ascending aorta and selected sinus replacement. All patients had degenerative AAA with sinotubular junction and partial root dilatation: one or two sinuses of Valsalva were involved. Mild to moderate-severe AR was present in all patients. The mean ± SD logistic EuroSCORE 1 was 15.4 ± 12.5. Twenty patients had ascending aorta replacement associated with noncoronary sinus replacement; 8 patients, associated with both right and noncoronary sinuses; 1 patient, associated with both left and noncoronary sinuses; and 1 patient, associated with left coronary sinus alone. RESULTS There were no hospital or late deaths. No thromboembolic event or bleeding complications were reported. Postoperative echocardiography did not show significant AR, and computed tomographic scanning revealed a normal positioning of the vascular graft in the ascending aorta. CONCLUSIONS Remodeling of the sinotubular junction with selected sinus replacement in degenerative AAA is a valuable approach for aortic root remodeling, leading to a significant reduction of AR when the aortic leaflets are normal.
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Fujiyoshi T, Hoashi T, Kagisaki K, Kurosaki K, Shiraishi I, Ichikawa H. The application of all-autologous three-sinus repair for supravalvular pulmonary stenosis. Pediatr Cardiol 2013; 34:1711-5. [PMID: 23619830 DOI: 10.1007/s00246-013-0698-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/28/2013] [Indexed: 11/29/2022]
Abstract
Various surgical techniques have been proposed for the repair of supravalvular pulmonary stenosis (SVPS) in pediatric populations. Whereas growth potential should be promised, excessive expansion under the presence of undiminished high pulmonary arterial pressure should be avoided. The authors applied all-autologous three-sinus repair, the so-called modified Brom or Myers technique, to SVPS and examined the midterm outcomes. Between March 2010 and March 2012, 15 patients (8 boys) with a median age of 12 months who had SVPS underwent all-autologous three-sinus repair. Of the 15 patients, 13 (87 %) had previously undergone pulmonary artery (PA) banding for treatment of high pulmonary vascular resistance. Two patients (13 %) had Noonan syndrome. A follow-up evaluation was completed for all the patients, and the median follow-up period was 13.5 months (range, 1 month to 2.4 years). No mortalities occurred. The diameter of the stenotic part at the main PA increased from 47.0 ± 14.1 % (range 29.1-70.0 %) of the normal PA diameter at the preoperative evaluation to 108.9 ± 25.7 % (range 58.9-148.1 %) at 6 months, and then to 104.7 ± 11.4 % (range 87.7-134.1 %) 1 year after the operation. The estimated mean pressure gradient across the main PA decreased from 76.2 ± 12.2 mmHg (range 57.8-108.2 mmHg) at the preoperative evaluation to 11.3 ± 12.0 mmHg (range 1.4-49.0 mmHg) at 6 months, and then to 6.4 ± 5.5 mmHg (range 2.0-19.4 mmHg) 1 year after the operation. No patients showed moderate or greater pulmonary insufficiency. The midterm outcomes after supravalvular pulmonary stenosis by all-autologous three-sinus repair were acceptable. Although a long-term follow-up evaluation is mandatory, application of this technique may provide a just enough growth of the reconstructed main pulmonary artery with symmetric pulmonary valve geometry.
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Affiliation(s)
- Toshiki Fujiyoshi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan,
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Sansone F, Zingarelli E, Ceresa F, Patanè F. Partial Aortic Root Remodeling in Case of Ascending Aortic Aneurysms. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fabrizio Sansone
- Division of Cardiac Surgery, Papardo-Piemonte Hospital, Messina, Italy
| | - Edoardo Zingarelli
- Division of Cardiac Surgery, Mauriziano Umberto I Hospital, Turin, Italy
| | - Fabrizio Ceresa
- Division of Cardiac Surgery, Papardo-Piemonte Hospital, Messina, Italy
| | - Francesco Patanè
- Division of Cardiac Surgery, Papardo-Piemonte Hospital, Messina, Italy
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Michalak KW, Moll JA, Moll M, Dryzek P, Moszura T, Kopala M, Mludzik K, Moll JJ. The neoaortic root in children with transposition of the great arteries after an arterial switch operation. Eur J Cardiothorac Surg 2013; 43:1101-8. [PMID: 23341041 DOI: 10.1093/ejcts/ezs709] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Neoaortic root changes in children with transposition of the great arteries (TGA) are reportedly risk factors for the development of neoaortic regurgitation (NeoAR). The aims of this study were to assess the neoaortic root diameter and relative proportion in children with TGA after surgical correction and to identify possible correlations with the development of neoaortic insufficiency. METHODS Of the 611 children who had the arterial switch operation performed in the Cardiology Department of the Polish Mother's Memorial Hospital, 172 consecutive patients were qualified for this study. The inclusion criteria were: anatomical correction performed during the neonatal period, more than 10 years of postoperative observation and at least two full echocardiographic examinations. RESULTS NeoAR increased during postoperative follow-up and at the end of the observation period, 76% of the patients had NeoAR (27%-trace, 42%-mild, 7%-moderate and 0.6%-severe). Among the analysed risk factors for NeoAR development, the significant ones were arterial valve discrepancy (OR = 2.05; 95% CI: 1.04-4.02; P = 0.031) and the non-facing commissures (OR = 4.05; 95% CI: 1.34-11.9; P = 0.01). The neoaortic root diameter was not statistically significantly correlated with the presence of NeoAR or with the heart defects associated with transposition. The neoaortic root was initially, on average, 37% (z-score = 1.58) bigger than the aortic root in healthy children. This disproportion increased during the follow-up evaluations to 57% (z-score = 2.09). CONCLUSIONS The neoaortic root in children after the arterial switch procedure develops differently from that in healthy children, but this is not evidently related to NeoAR development or associated heart defects.
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Affiliation(s)
- Krzysztof W Michalak
- Department of Cardiology and Cardiosurgery, Polish Mother's Memorial Hospital, Lodz, Poland.
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Fan R, Bayoumi AS, Chen P, Hobson CM, Wagner WR, Mayer JE, Sacks MS. Optimal elastomeric scaffold leaflet shape for pulmonary heart valve leaflet replacement. J Biomech 2013; 46:662-9. [PMID: 23294966 DOI: 10.1016/j.jbiomech.2012.11.046] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/23/2012] [Accepted: 11/25/2012] [Indexed: 11/30/2022]
Abstract
Surgical replacement of the pulmonary valve (PV) is a common treatment option for congenital pulmonary valve defects. Engineered tissue approaches to develop novel PV replacements are intrinsically complex, and will require methodical approaches for their development. Single leaflet replacement utilizing an ovine model is an attractive approach in that candidate materials can be evaluated under valve level stresses in blood contact without the confounding effects of a particular valve design. In the present study an approach for optimal leaflet shape design based on finite element (FE) simulation of a mechanically anisotropic, elastomeric scaffold for PV replacement is presented. The scaffold was modeled as an orthotropic hyperelastic material using a generalized Fung-type constitutive model. The optimal shape of the fully loaded PV replacement leaflet was systematically determined by minimizing the difference between the deformed shape obtained from FE simulation and an ex-vivo microCT scan of a native ovine PV leaflet. Effects of material anisotropy, dimensional changes of PV root, and fiber orientation on the resulting leaflet deformation were investigated. In-situ validation demonstrated that the approach could guide the design of the leaflet shape for PV replacement surgery.
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Affiliation(s)
- Rong Fan
- Department of Biomedical Engineering and the Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX, United States
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Surgical Correction of Ascending Aortic Aneurysm and Aortic Valve Incompetence by Relocation of the Aortic Valve Plane Using a Short Aortic Replacement Graft. Ann Thorac Surg 2012; 94:1983-8; discussion 1988-9. [DOI: 10.1016/j.athoracsur.2012.07.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 07/13/2012] [Accepted: 07/16/2012] [Indexed: 11/24/2022]
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Mazzola A, Di Mauro M, Pellone F, Faragalli F, Villani C, Di Eusanio M, Gizzi G, Lemme E, Gregorini R, Romano S, Penco M. Freestyle Aortic Root Bioprosthesis Is a Suitable Alternative for Aortic Root Replacement in Elderly Patients: A Propensity Score Study. Ann Thorac Surg 2012; 94:1185-90. [DOI: 10.1016/j.athoracsur.2012.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/27/2012] [Accepted: 05/02/2012] [Indexed: 11/24/2022]
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Ro SK, Kim JB, Hwang SK, Jung SH, Choo SJ, Chung CH, Lee JW. Aortic root conservative repair of acute type A aortic dissection involving the aortic root: fate of the aortic root and aortic valve function. J Thorac Cardiovasc Surg 2012; 146:1113-8. [PMID: 22995725 DOI: 10.1016/j.jtcvs.2012.08.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/18/2012] [Accepted: 08/23/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite many studies about aortic valve function and aortic root geometry after conservative aortic root repair of acute type A aortic dissection, the results are not always consistent or conclusive. This study aims to evaluate aortic root diameter and aortic valve function after surgery for acute type A aortic dissection involving the aortic root. METHODS A retrospective review was performed of 196 consecutive patients (age, 56.9 ± 11.4 years; 96 men) who underwent conservative aortic root repair including sinotubular junction resuspension for the management of acute type A aortic dissection involving the aortic root. RESULTS The 30-day mortality rate was 5.1% (n = 10). During a median follow-up period of 45.3 ± 36.4 months, there were 28 deaths and 11 cases of aortic reoperation (proximal reoperation in 1 and distal reoperation in 10). Of the 6-month survivors (n = 177, 90.3%), echocardiography and computed tomography were performed in the late period (>6 months) on 115 (65.0%) and 138 (78.0%), respectively. Significant aortic regurgitation (greater than grade 2+) or root dilatation (>45 mm) was observed in 5 and 19 patients, respectively. Freedom from aortic regurgitation (greater than grade 2+) or root dilatation (>45 mm) at 5 years was 84.6% ± 3.9%. On the Cox regression analysis, the maximal aortic root diameter at initial presentation was the only significant predictor of aortic regurgitation and aortic root dilatation (hazard ratio, 1.10; 95% confidence interval, 1.02-1.19; P = .014). CONCLUSIONS Conservative aortic root repair of acute type A aortic dissection demonstrates acceptable long-term clinical outcomes. However, more aggressive approaches should be considered for patients who have aortic root dilatation because of the risk of developing a root aneurysm after surgery.
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Affiliation(s)
- Sun Kyun Ro
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Jhang WK, Shin HJ, Park JJ, Yun TJ, Kim YH, Ko JK, Park IS, Seo DM. The importance of neo-aortic root geometry in the arterial switch operation with the trap-door technique in the subsequent development of aortic valve regurgitation. Eur J Cardiothorac Surg 2012; 42:794-9; discussion 799. [DOI: 10.1093/ejcts/ezs169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Asano M, Kunihara T, Aicher D, El Beyrouti H, Rodionycheva S, Schäfers HJ. Mid-term results after sinutubular junction remodelling with aortic cusp repair. Eur J Cardiothorac Surg 2012; 42:1010-5. [PMID: 22504894 DOI: 10.1093/ejcts/ezs120] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES An ascending aortic aneurysm with aortic valve regurgitation (AR) may be treated by sinutubular junction remodelling (STJR) with aortic cusp repair if the root diameter is preserved. We analysed the outcome of STJR with cusp repair. METHODS Between 1995 and 2010, 1094 patients underwent valve-preserving surgery. Of these, 560 individuals with root replacement, 128 patients with acute aortic dissection and 262 patients with preoperative AR ≤ II were excluded. The remaining 144 patients (mean age 56.0 ± 17.0 years, 103 males) underwent STJR ± cusp repair for ascending aortic aneurysm and AR ≥ III. In all, sinus dimensions were preserved according to the following criteria: maximum diameter ≤42 mm in bicuspid aortic valve (BAV, n = 59) and unicuspid aortic valve (UAV, n = 27), and ≤45 mm in tricuspid aortic valves (TAV, n = 58). In BAV, right-left (n = 52) and right-non-coronary (n = 7) cusp fusions were seen. To evaluate the influence of valve morphology, patients were divided into two groups: TAV and non-TAV. The patients with non-TAV were younger (P < 0.01) and had less concomitant cardiac surgery (P < 0.01). The mean follow-up was 25.9 ± 22.0 months. RESULTS Early mortality was 2.1% (n = 3). The causes of death were cardiac (n = 1), respiratory (n = 1) and mesenteric ischaemia (n = 1). Higher age was the predictor of early mortality by multivariate analysis (P = 0.04, hazard ratio 13.2). Overall 5-year survival was 93.9 ± 2.9% (TAV, 82.8 ± 10.2%; non-TAV, 98.5 ± 1.5%; P = 0.02). Causes of late death were cardiac (n = 1), respiratory (n = 1) and carcinoma (n = 1). Freedom from recurrent AR ≥ III at 5 years was 80.1 ± 7.7% (TAV, 97.0 ± 3.0%; non-TAV, 73.4 ± 8.7%; P = 0.02). By multivariate analysis, only aortoventricular junction (AVJ) > 28 mm (P < 0.01, hazard ratio 9.7) was a predictor of recurrent AR. Freedom from reoperation at 5 years was 81.9 ± 7.8% (TAV, 97.0 ± 3.0%; non-TAV, 76.6 ± 8.8%; P < 0.05). The causes of reoperation (five re-aortic valve repairs and four valve replacements) were dehiscence of pericardial patch (n = 7) and recurrent cusp prolapse (n = 2). By multivariate analysis, only AVJ > 28 mm was a significant predictor for reoperation (P < 0.01, hazard ratio 11.6). CONCLUSIONS STJR with cusp repair is a useful technique in patients with an ascending aortic aneurysm and relevant AR. Although the dilated AVJ is a risk of recurrent AR and reoperation, concomitant cusp repair is associated with an acceptable mid-term outcome.
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Affiliation(s)
- Mitsuru Asano
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg/Saar, Germany
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Aortic root aneurysm: principles of repair and long-term follow-up. J Thorac Cardiovasc Surg 2010; 140:S14-9; discussion S45-51. [PMID: 21092781 DOI: 10.1016/j.jtcvs.2010.07.041] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/12/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study was undertaken to examine clinical and echocardiographic outcomes of aortic valve-sparing operations to treat aortic root aneurysms. METHODS From May 1988 to December 2007, a total of 228 patients underwent reimplantation of the aortic valve, and 61 underwent remodeling of the aortic root. Patients were followed up prospectively and had echocardiographic evaluation of valve function. Mean follow-up was 7.28 ± 4.33 years. RESULTS There were 5 operative and 26 late deaths. Survival at 12 years was 82.9 ± 3.7% and similar between types of operations. Age and aortic dissection were independent predictors of mortality. Seven patients have had reoperations on the aortic valve: 6 for aortic insufficiency and 1 for endocarditis. Five of these patients had undergone remodeling of the aortic root. Freedoms from reoperation at 12 years were 94.3% ± 2.6% among all patients, 90.4% ± 4.7% after remodeling, and 97.4% ± 2.2% after reimplantation (P = .09). Postoperatively, moderate aortic insufficiency developed in 14 patients (8 remodeling and 6 reimplantation) and severe aortic insufficiency in 5 (3 remodeling and 2 reimplantation). The remaining patients had mild, trace, or no aortic insufficiency. Freedoms from moderate or severe aortic insufficiency at 12 years were 86.8% ± 3.8% among all patients, 82.6% ± 6.2% after remodeling, and 91.0% ± 3.8% after reimplantation (P = .035). Only age-by 5-year increments-was an independent predictor of postoperative aortic insufficiency. CONCLUSIONS Aortic valve-sparing operations provide excellent patient survival and stable aortic valve function, particularly after reimplantation of the aortic valve.
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Praveen Kumar G, Mathew L. Three-Dimensional Computer-Aided Design-Based Geometric Modeling of a New Trileaflet Aortic Valve. Artif Organs 2010; 34:1121-4. [DOI: 10.1111/j.1525-1594.2009.00973.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Aortic valve pathophysiology during left ventricular assist device support. J Heart Lung Transplant 2010; 29:1321-9. [PMID: 20674397 DOI: 10.1016/j.healun.2010.06.006] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 05/24/2010] [Accepted: 06/08/2010] [Indexed: 11/23/2022] Open
Abstract
The increased applicability and excellent results with left ventricular assist devices (LVADs) have revolutionized the available treatment options for patients with advanced heart failure. Pre-existing valve abnormalities are common in this population, and subsequent development of valve abnormalities after LVAD placement is also often noted. Although native mitral and tricuspid valve disease is more common in heart failure patients before LVAD placement, aortic valves are much more likely to generate abnormal pathophysiology in the LVAD patient during as well as after LVAD placement. The aim of this comprehensive review is to review aortic valve function in LVAD patients and highlight the consideration of pre-existing valve disease on patient treatment at the time of LVAD implant. The basis for structural changes leading to valve pathophysiology during and after LVAD placement will be described, providing a basis for improved clinical understanding and new strategies to prevent these conditions.
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David TE. Preoperative selection of patients for aortic valve repair. Rev Esp Cardiol 2010; 63:513-5. [PMID: 20450843 DOI: 10.1016/s1885-5857(10)70111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Imai K, Watanabe N, Saito K, Hayashida A, Maehama T, Miyamoto Y, Kawamoto T, Neishi Y, Okura H, Yoshida K. Quantitative measurements of aortic valve coaptation by three-dimensional transesophageal echocardiography in patients with aortic regurgitation without primary leaflet disease. J Echocardiogr 2009; 8:7-13. [DOI: 10.1007/s12574-009-0028-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 07/23/2009] [Accepted: 07/28/2009] [Indexed: 11/30/2022]
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Morimoto N, Matsumori M, Tanaka A, Munakata H, Okada K, Okita Y. Adjustment of Sinotubular Junction for Aortic Insufficiency Secondary to Ascending Aortic Aneurysm. Ann Thorac Surg 2009; 88:1238-43. [DOI: 10.1016/j.athoracsur.2009.05.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 05/10/2009] [Accepted: 05/13/2009] [Indexed: 10/20/2022]
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Vivancos R, Aranda P. Aportación de la ecocardiografía en la valoración de la enfermedad aórtica. CIRUGIA CARDIOVASCULAR 2009. [DOI: 10.1016/s1134-0096(09)70129-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Sinus of Valsalva dilates disproportionately in aortic root aneurysm with moderate to severe aortic regurgitation: quantitative assessment by transesophageal echocardiography. J Echocardiogr 2009; 7:41-7. [DOI: 10.1007/s12574-009-0012-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 05/14/2009] [Accepted: 05/19/2009] [Indexed: 11/25/2022]
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[Pathobiology of idiopathic ascending aortic aneurysms]. Presse Med 2008; 38:1076-88. [PMID: 19070988 DOI: 10.1016/j.lpm.2008.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 08/09/2008] [Accepted: 09/18/2008] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The majority of ascending aortic aneurysms cannot be related to any specific etiology and should be qualified as idiopathic. The incidence of this disease is increasing in the population of the developed countries but its pathobiology is poorly understood. AIM This article is reviewing the publications concerning the pathobiology of idiopathic ascending aortic aneurysms. SOURCES A PubMed search on articles published in English or French, between January 1965 and December 2007, on key-words << aortic root >>, << ascending aorta >>, << aortic arch >>, << thoracic aorta >>, << aneurysm >>, << dilatation >> and << dissection >> was undertaken. Articles on aneurysms related to inflammatory and infectious diseases, congenital or genetic syndromes were excluded. RESULTS The presented data suggests that destructive remodeling of the aortic wall, inflammation and angiogenesis, biomechanical wall stress, and molecular genetics are relevant mechanisms of idiopathic ascending aortic aneurysm formation and progression. LIMITS Sparse data available from few direct studies offer limited knowledge on pathobiology of idiopathic ascending aortic aneurysms. CONCLUSION A more intimate knowledge of the triggers and perpetrating factors of this disease might offer new diagnostic and treatment options.
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Postimplantation morphologic changes of glutaraldehyde-fixed porcine aortic roots and risk of aneurysm and rupture. J Thorac Cardiovasc Surg 2008; 137:94-100. [PMID: 19154910 DOI: 10.1016/j.jtcvs.2008.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 06/24/2008] [Accepted: 07/02/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Rupture of glutaraldehyde-fixed porcine aortic roots has been reported, but the mechanism and incidence of this complication is unknown. This study evaluates the clinical outcomes and the risk of dilation and rupture of porcine aortic roots after implantation. METHODS Commercially available porcine aortic roots were used for aortic root replacement in 308 patients (Freestyle bioprosthesis [Medtronic, Minneapolis, Minn] in 251 patients and Toronto Root [St Jude Medical, St Paul, Minn] in 57 patients) whose mean age was 62 +/- 13 years. The main indication for aortic root replacement was dilation of the native aortic root. Clinical follow-up was complete at a mean of 5.3 +/- 2.5 years. Valve function and aortic root diameter were assessed by means of echocardiography. RESULTS There were 10 (3.2%) operative and 39 (12.6%) late deaths. At 8 years, patients' survival was 79.0% +/- 3.1%, freedom from reoperation was 95.3% +/- 1.7%, and freedom from severe aortic insufficiency was 93.8% +/- 2.7%. The diameter of the aortic sinuses increased from 31.9 +/- 4.3 to 34.1 +/- 4.8 mm (P < .0001), and it exceeded 40 mm in 10% of the patients. Linear regression analysis revealed that the duration of follow-up (P < .0001) and the size of the valve implanted (P < .0001) were associated with risk of sinus dilation. There was only 1 early rupture of the noncoronary aortic sinus and 2 late aneurysms that required repeat operations. Histologic examination of explanted aneurysmal porcine roots revealed marked changes in the xenograft arterial wall, with abundant mononuclear cells suggestive of immunologic reaction. CONCLUSIONS Mild dilation of porcine aortic roots after aortic root replacement is common, but aneurysm formation and rupture are rare during the first decade of follow-up. Annual surveillance with echocardiography is recommended.
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Birincioglu CL, Mavioglu L, Yavas S, Demirtas E, Altıntas G, Iscan HZ. Single-Stage Repair of Acute Type A Aortic Dissection Associated With Aortic Coarctation, Perimembranous Ventricular Septal Defect, and Bicuspid Aortic Valve. Ann Thorac Surg 2008; 86:284-7. [DOI: 10.1016/j.athoracsur.2007.12.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 11/12/2007] [Accepted: 12/17/2007] [Indexed: 12/21/2022]
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Rupture of fibrous bands associated with aortic root dilatation. J Thorac Cardiovasc Surg 2008; 135:218-9. [PMID: 18179951 DOI: 10.1016/j.jtcvs.2007.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 08/10/2007] [Accepted: 09/11/2007] [Indexed: 11/20/2022]
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Maselli D, De Paulis R, Scaffa R, Weltert L, Bellisario A, Salica A, Ricci A. Sinotubular Junction Size Affects Aortic Root Geometry and Aortic Valve Function in the Aortic Valve Reimplantation Procedure: An In Vitro Study Using the Valsalva Graft. Ann Thorac Surg 2007; 84:1214-8. [PMID: 17888972 DOI: 10.1016/j.athoracsur.2007.05.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 05/09/2007] [Accepted: 05/11/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sinotubular junction (STJ) size in aortic valve reimplantation procedures is usually predetermined on the basis of experience or intraoperative mathematical calculations. Given the small coaptation reserve of aortic valve leaflets, small errors can produce an incompetent aortic valve. We tested in vitro the effect of geometrically changing the relationship between aortic annulus size and STJ size on aortic root geometry and aortic valve function. METHODS Twenty-five-millimeter diameter scalloped porcine aortic roots were reimplanted into 32-mm Valsalva grafts (Vascutek, Renfrewshire, Scotland), suspending commissures into the expandable region of the graft itself. Neoaortic roots were pressurized up to 100 mm Hg. Sinotubular junction size was then changed by wrapping the neocommissural ridge with Dacron rings of decreasing size. Geometry of the aortic root, anatomy of aortic valve leaflets, and extent of their coaptation were analyzed by direct endoscopic view and by ultrasound imaging techniques. RESULTS Pressurizing unwrapped aortic root resulted in centrifugal displacement of commissures, aortic leaflets tethering and bending, and central aortic regurgitation. By reducing STJ size, coaptation height of aortic valve leaflets first increased to reach a maximum for an STJ size corresponding to 30 mm, and then decreased for further reduction of STJ size. Excess reduction of STJ size also resulted in prolapsed aortic leaflets and eccentric aortic regurgitation. CONCLUSIONS In the reimplantation procedure performed with a Valsalva graft, aortic valve function and leaflet coaptation can be optimized by optimizing STJ size.
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Affiliation(s)
- Daniele Maselli
- Department of Cardiac Surgery, European Hospital, Rome, Italy.
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Abstract
Each heart valve is composed of different structures of which each one has its own histological profile. Although the aortic and the pulmonary valves as well as the mitral and the tricuspid valves show similarities in their architecture, they are individually designed to ensure optimal function with regard to their role in the cardiac cycle. In this article, we systematically describe the structural elements of the four heart valves by different anatomical, light- and electron-microscopic techniques that have been presented. Without the demand of completeness, we describe main structural features that are in our opinion of importance in understanding heart valve performance. These features will also have important implications in the treatment of heart valve disease. They will increase the knowledge in the design of valve substitutes or partial substitutes and may participate to improve reconstructive techniques. In addition, understanding heart valve macro- and microstructure may also be of benefit in heart valve engineering techniques.
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Affiliation(s)
- Martin Misfeld
- University of Luebeck, Clinic of Cardiac and Thoracic Surgery, Ratzeburger Allee 160, 23538 Luebeck, Germany.
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Maselli D, Guarracino F, Bajona P, Bellieni L, Minzioni G. Adjustable Sinotubular Junction for Aortic Valve Reimplantation Procedures. Ann Thorac Surg 2007; 83:700-2. [PMID: 17258026 DOI: 10.1016/j.athoracsur.2006.04.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Revised: 03/22/2006] [Accepted: 04/24/2006] [Indexed: 10/23/2022]
Abstract
Sinotubular junction size in aortic valve reimplantation procedures is usually predetermined on the basis of mathematical calculations and intraoperative measurements. We propose a new method for aortic valve reimplantation by which intraoperative measurements can be eliminated and sinotubular junction size adjusted after cross clamp removal to fit the patient's need. Aortic valve commissures are reimplanted in the expandable skirt of a Valsalva (Vascutek, Renfrewshire, Scotland) graft to realize an oversized sinotubular junction that is subsequently reduced to the proper size by wrapping, with Dacron rings of decreasing size, the neo-sinotubular ridge under transesophageal echocardiographic guidance.
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Affiliation(s)
- Daniele Maselli
- Cardiothoracic Department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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Labrosse MR, Beller CJ, Robicsek F, Thubrikar MJ. Geometric modeling of functional trileaflet aortic valves: Development and clinical applications. J Biomech 2006; 39:2665-72. [PMID: 16199047 DOI: 10.1016/j.jbiomech.2005.08.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 08/19/2005] [Indexed: 11/29/2022]
Abstract
The dimensions of the aortic valve components condition its ability to prevent blood from flowing back into the heart. While the theoretical parameters for best trileaflet valve performance have already been established, an effective approach to describe other less optimal, but functional models has been lacking. Our goal was to establish a method to determine by how much the dimensions of the aortic valve components can vary while still maintaining proper function. Measurements were made on silicone rubber casts of human aortic valves to document the range of dimensional variability encountered in normal adult valves. Analytical equations were written to describe a fully three-dimensional geometric model of a trileaflet valve in both the open and closed positions. A complete set of analytical, numerical and graphical tools was developed to explore a range of component dimensions within functional aortic valves. A list of geometric guidelines was established to ensure safe operation of the valve during the cardiac cycle, with practical safety margins. The geometry-based model presented here allows determining quickly if a certain set of valve component dimensions results in a functional valve. This is of great interest to designers of new prosthetic heart valve models, as well as to surgeons involved in valve-sparing surgery.
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Affiliation(s)
- Michel R Labrosse
- University of Ottawa, Department of Mechanical Engineering, Ottawa, Ontario, Canada.
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Furukawa K, Ohteki H, Cao ZL, Narita Y, Okazaki Y, Ohtsubo S, Itoh T. Evaluation of native valve-sparing aortic root reconstruction with direct imaging--reimplantation or remodeling? Ann Thorac Surg 2004; 77:1636-41. [PMID: 15111157 DOI: 10.1016/j.athoracsur.2003.09.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aortic root reimplantation and remodeling have been used to preserve the native aortic valve. However, direct observation of valve motions with these techniques has not been performed. METHODS Mongrel dogs were studied. The beating heart model was created using modified Tyrode's solution. Normal aortic valves and aortic valves preserved with the remodeling or reimplantation procedure were observed with an endoscope, and behavior was recorded on a high-speed video (200 frames/s). The aortic valve orifice area was measured at 11 data points per beat. A predictable maximum valve orifice area was defined as an area encircled by the three commissures. A ratio of each aortic valve orifice area to the predictable maximum valve orifice area was calculated. The control group, the reimplantation group, and the remodeling group were compared. RESULTS The preserved aortic valve with reimplantation showed bending and asymmetric motion. The ratio of aortic valve orifice area and predictable maximum valve orifice area in the reimplantation group was significantly smaller compared with the control and remodeling groups. CONCLUSIONS The opening and closing behavior of the aortic valve preserved with the reimplantation procedure was impaired. It was speculated that the remodeling procedure may preserve more physiologic root function compared with the reimplantation procedure.
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Affiliation(s)
- Kojiro Furukawa
- Department of Thoracic and Cardiovascular Surgery, Saga Medical School, and Department of Cardiovascular Surgery, Saga Prefectural Hospital, Koseikan, Saga, Japan.
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Formigari R, Toscano A, Giardini A, Gargiulo G, Di Donato R, Picchio FM, Pasquini L. Prevalence and predictors of neoaortic regurgitation after arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 2003; 126:1753-9. [PMID: 14688683 DOI: 10.1016/s0022-5223(03)01325-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The fate of the native pulmonary valve after arterial switch operation is still unknown and may become a cause for a secondary aortic valve operation during adult life. We evaluated the prevalence and predictive factors associated with neoaortic valvular regurgitation by a retrospective study of children who underwent arterial switch operation for transposition of the great arteries. METHODS The onset of neoaortic valvular regurgitation was correlated with demographic data, cardiac anatomy, surgical technique, and postoperative ventricular function. The size of the neoaortic root and ascending aorta was measured in a selected subset of patients. RESULTS Among 253 survivors, 173 were eligible for the study. After a median follow-up time of 8.2 years, 61 patients showed echocardiographic or angiographic evidence of valvular incompetence, which was progressive in 14 cases; this led to surgical intervention in 2 patients, and there was 1 operative death. At multivariate analysis, the onset of valvular regurgitation was correlated with the trap-door technique for coronary reimplantation (P <.01). A smooth transition from the aortic sinus to the ascending aorta, with loss of the normal sinotubular junction geometry, may be associated with valvular incompetence. CONCLUSIONS After arterial switch operation, there is an increasing frequency of neoaortic regurgitation, which may lead to significant valvular dysfunction later in life. The trap-door type of coronary reimplantation is associated with an increased risk for valvular dysfunction, possibly because of a distortion of the sinotubular junction geometry. For this reason, we recommend the punch technique for repair in all but the most complicated coronary pattern.
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Affiliation(s)
- Roberto Formigari
- Pediatric Cardiology and Cardiac Surgery, University of Bologna, Italy.
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Leyh RG, Kallenbach K, Karck M, Hagl C, Fischer S, Haverich A. Impact of preoperative aortic root diameter on long-term aortic valve function after valve sparing aortic root reimplantation. Circulation 2003; 108 Suppl 1:II285-90. [PMID: 12970247 DOI: 10.1161/01.cir.0000087429.48264.81] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Valve sparing aortic root reimplantation technique in patients with aortic root aneurysm have shown excellent mid-term results. In conjunction with the diameter of the aortic root the mechanical leaflet stress increase, which might have an impact on long-term aortic valve function after valve sparing aortic root reimplantation. METHODS AND RESULTS From July 1993 to October 2001, 168 patients with aortic root aneurysm underwent valve sparing aortic root reimplantation. Patients with type A aortic dissection were excluded. Thus, 123 patients were analyzed. We identified 47 patients with an preoperative aortic root diameter exceeding 60 mm (group A), 58 patients with an diameter between 50 and 60 mm (group B), and 18 patients with a diameter less than 50 mm (group C). The groups were compared regarding mortality, long-term survival, freedom from reoperation, freedom from severe and moderate aortic valve insufficiency (AI), and postoperative morbidity. Mean follow-up (group A 43+/-26 months, group B 40+/-25 months, group C 23+/-19 months; group C versus group A, P=0.005; group C versus group B, P=0.011) was shorter in group C. Perioperative mortality (group A 2.2%, group B 1.9%, group C 5.2%; P=ns) was comparable between the groups with each one patient. The 3-year survival for group A was 98+/-2%, for group B 96+/-3%, and for group C 100+/-0% (P=ns). Freedom from reoperation for group A was 98+/-2%, for group B 96+/-3%, and for group C 88+/-8% (P=ns). Four patients developed severe or moderate AI, thus freedom from severe and moderate AI for group A was 100+/-0%, for group B 88+/-8%, and for group C 94+/-5% (P=ns). During follow-up no thromboembolic or bleeding events were noticed. CONCLUSIONS Our data show that the preoperative diameter of the aortic root has no impact on the longevity of the repair. Thus, the reimplantation technique can be recommended for all patients presenting with an aortic root aneurysm and normal leaflets regardless of the aortic root diameter.
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Affiliation(s)
- R G Leyh
- Division of Thoracic and Cardiovascular Surgery, Hanover Medical School, Hanover, Germany.
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Fullerton DA, Fredericksen JW, Sundaresan RS, Horvath KA. The Ross procedure in adults: intermediate-term results. Ann Thorac Surg 2003; 76:471-6; discussion 476-7. [PMID: 12902087 DOI: 10.1016/s0003-4975(03)00532-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The durability of the Ross procedure may be optimized by appropriate geometric matching of the aortic and pulmonary artery roots. We employed a surgical strategy to standardize the operation in order to avoid more readily a geometric mismatch. METHODS The Ross procedure was performed as a root replacement. Without regard for patient body surface area, the aortic annulus was plicated to 23 mm and externally buttressed with felt. Geometric mismatch of the distal autograft anastomosis was avoided by liberal use of a synthetic interposition graft, and the anastomosis was also externally buttressed with felt. An over-sized pulmonary homograft (27 to 28 mm) was routinely used to reconstruct the right ventricular outflow tract. RESULTS Forty-four consecutive patients (27 men and 17 women; mean age, 49 +/- 9 years) were operated on between January 1997 and March 2002. Mean follow-up was 38 +/- 5 months. Twenty-nine patients had aortic stenosis and 15 had aortic regurgitation. Aortic annular plication was done in 41 (93%) and an aortic interposition was used in 14 (32%). There were three hospital deaths, with no subsequent deaths. Only 1 patient required reoperation 2.5 years postoperatively from recurrent endocarditis. No patient has more that "trivial" autograft insufficiency, and the mean autograft gradient was 7 +/- 3 mm Hg. No patient has significant pulmonary homograft stenosis. CONCLUSIONS Geometric matching of the aortic and pulmonary roots may be readily accomplished using a standardized approach to the Ross procedure. In turn, this may optimize the durability of the operation.
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Affiliation(s)
- David A Fullerton
- Division of Cardiothoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Leyh RG, Kofidis T, Fischer S, Kallenbach K, Harringer W, Haverich A. Aortic root reimplantation for successful repair of an insufficient pulmonary autograft valve after the Ross procedure. J Thorac Cardiovasc Surg 2002; 124:1048-9. [PMID: 12407400 DOI: 10.1067/mtc.2002.124882] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Rainer G Leyh
- Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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Watanabe H, Hayashi JI, Takahashi M, Takekubo M, Tosaka Y. Aortic root endoscopy in pediatric cardiac operations for aortic valvuloplasty. J Card Surg 2002; 17:398-9. [PMID: 12630537 DOI: 10.1111/j.1540-8191.2001.tb01166.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We use aortic root endoscopy for assessment of the aortic valve in pediatric patients. A flexible fiberscope inserted through the ascending aorta provides clear and precise visualization of the aortic valve. This technique of endoscopic assessment will help to judge the cusp prolapse and malcoaptation of the aortic valve in pediatric aortic surgery.
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Affiliation(s)
- Hiroshi Watanabe
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata City, Niigata, Japan.
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Ohtsubo S, Itoh T, Furukawa K, Rikitake K, Okazaki Y, Natsuaki M. Geometrical difference between an ascending aneurysm and a root aneurysm in valve-sparing operations. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2002; 50:59-65. [PMID: 11905059 DOI: 10.1007/bf02919666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aortic root geometry of the leaflet size and coaptation in an ascending aortic aneurysm, and in a root aneurysm, may predict the early and late outcomes from valve-sparing surgery. METHODS The aortic root was investigated using intraoperative endoscopy before and after valve-sparing root reconstruction. The definition of 'root aneurysm' was marked sinus dilatation proximal to the sinotubular junction. 'Ascending aneurysm' was defined as dominant dilatation distal from the sinotubular junction. Fifteen cases were examined and classified into two groups; Group A with an ascending aneurysm (four patients), and Group R with a root aneurysm (eleven patients). RESULTS Cusp prolapse was seen in 10 (90.9%) patients of Group R, and in only one (25%) patient of Group A. The length of the free margin of all cusps in Group R was significantly longer than those in Group A. In Group R, the lengths of the free margin of an individual cusp were significantly different, indicating asymmetric cusps. In Group A, the length of the free margin were similar, indicating symmetric cusps. There was no significant difference in the degree of immediate postoperative aortic insufficiency, between the two groups. At the most recent follow-up, progressive aortic insufficiency was present in two patients of Group R. CONCLUSIONS A root aneurysm had asymmetric, elongated and prolapsed aortic cusps, while an ascending aneurysm had symmetric cusps without prolapse. The mechanism of aortic insufficiency in a root aneurysm was more complex, suggesting a difficulty in achieving long-term valve competence. Such geometrical difference should be considered in the indication for the surgical technique of valve-sparing operations.
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Affiliation(s)
- Satoshi Ohtsubo
- Department of Thoracic and Cardiovascular Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-0501, Japan
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