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Jo JJ, Kim YS, Kim GJ, Kim JH. True Aneurysm of the Common Coronary Button in a Marfan Patient with an Anomalous Right Coronary Artery after a Bentall Procedure: A Case Report. J Chest Surg 2022; 55:243-245. [PMID: 35638121 PMCID: PMC9178298 DOI: 10.5090/jcs.22.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/14/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022] Open
Abstract
True aneurysms of the coronary artery after aortic root replacement in Marfan syndrome patients are very rare. An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva adds complexity during aortic root surgery. We present a case of a 37-year-old male patient with Marfan syndrome who had an RCA anomaly and a 4.5-cm true aneurysm of the common coronary button 14 years after a previous Bentall procedure. A redo Bentall operation and hemi-arch replacement were successfully performed. The anomalous origin of the RCA from the left sinus of Valsalva was safely divided and anastomosed as separate coronary buttons to the prosthetic composite valve graft. To prevent coronary button aneurysms after aortic root surgery in Marfan patients, the coronary buttons and the corresponding side holes on the prosthetic graft must be reduced to the maximum possible extent.
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Affiliation(s)
- Jeong Jun Jo
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Yun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Gun-Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Virmani R, Sato Y, Sakamoto A, Romero ME, Butany J. Aneurysms of the aorta: ascending, thoracic, and abdominal and their management. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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3
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Saku K, Takagi K, Fukuda T, Tayama E, Tanaka H. Short-segment coronary artery bypass grafting using radial artery to repair bilateral coronary ostial aneurysms after aortic root replacement in a patient with Marfan syndrome. J Card Surg 2021; 36:3399-3401. [PMID: 34053120 DOI: 10.1111/jocs.15684] [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: 12/27/2020] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
Coronary ostial aneurysm is a complication of aortic root replacement, particularly in Marfan syndrome. Reconstructing the coronary artery is an important problem during reoperation. Herein, we report a case of coronary artery bypass grafting using radial artery to repair bilateral coronary ostial aneurysms after aortic root replacement in a patient with Marfan syndrome.
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Affiliation(s)
- Kosuke Saku
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Kazuyoshi Takagi
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Tomofumi Fukuda
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Eiki Tayama
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
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Jeudy J, White CS, Kligerman SJ, Killam JL, Burke AP, Sechrist JW, Shah AB, Hossain R, Frazier AA. Spectrum of Coronary Artery Aneurysms: From the Radiologic Pathology Archives. Radiographics 2018; 38:11-36. [DOI: 10.1148/rg.2018170175] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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5
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Ladich E, Butany J, Virmani R. Aneurysms of the Aorta. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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6
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Kim TS, Na CY, Oh SS, Kim JH. Long-term mortality and morbidity after button Bentall operation. J Card Surg 2013; 28:280-4. [PMID: 23480627 DOI: 10.1111/jocs.12085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The purpose of this study is to evaluate the long-term outcomes of the button Bentall procedure for the correction of aortic root disease. METHODS A total of 195 patients who underwent the button Bentall procedure between 1997 and 2010 were studied. The main pathology was annuloaortic ectasia. A mechanical valve was used in 163 patients (83.6%). The median duration of follow-up was 64 months (14133.0 patient-years). RESULTS There were five operative deaths (2.6%). Late overall mortality was 7.9%. The actuarial overall survival rate was 95.8 ± 1.5% at 5 years, 89.6 ± 3.4% at 10 years, and 75.9 ± 7.3% at 15 years. Multivariate logistic regression analysis identified preoperative poor mobility, cardiopulmonary bypass time, deep hypothermic circulatory arrest (DHCA) use, embolism, and bleeding event as significant independent risk factors for the late overall mortality. At 5, 10, and 15 years, actuarial composite valve graft-related event-free survival was 85.8 ± 2.8%, 75.5 ± 4.4%, and 69.3 ± 7.3%, respectively. Hypertension and concomitant coronary artery bypass graft (CABG) were independent predictors of composite valve graft-related events. Age, concomitant CABG, and DHCA use were associated with bleeding. CONCLUSIONS Valve-related morbidities, such as embolism and bleeding, determine the long-term overall mortality in aortic root replacement with button Bentall operation, similar to that in routine valve surgery.
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Affiliation(s)
- Tae Sik Kim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
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7
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Tamura K, Arai H, Kawaguchi S, Makita S, Miyagi N, Watanabe T, Fujiwara T. Long-Term Results of Modified Bentall Procedure Using Flanged Composite Aortic Prosthesis. Ann Thorac Cardiovasc Surg 2013; 19:126-30. [DOI: 10.5761/atcs.oa.12.01943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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8
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Kalkat MS, Edwards MB, Taylor KM, Bonser RS. Composite aortic valve graft replacement: mortality outcomes in a national registry. Circulation 2007; 116:I301-6. [PMID: 17846321 DOI: 10.1161/circulationaha.106.681437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Composite aortic valve and root replacement (CVG) is a complex surgical procedure, but excellent center-specific outcomes are reported. We sought to report outcomes in a national cohort. METHODS AND RESULTS The United Kingdom Heart Valve Registry was interrogated for 1962 first-time CVG (and 37,102 aortic valve replacements [AVR] as a reference group) procedures from 1986 to 2004. We analyzed 30-day mortality, long-term survival (97.2% complete follow-up), and examined available risk factors for mortality using univariate and multivariate logistic regression analysis and causes of death. CVG patients were younger, received larger valve sizes and were more likely to be emergent than AVR patients. Overall 30-day mortality was 10.7% (CVG) and 3.6% (AVR). For CVG, multivariate analysis identified advanced age (> 70 years), concomitant coronary artery surgery, impaired left ventricular function, urgent or emergency status, prosthetic valve size < or = 23 mm and hospital activity volume < or = 8 procedures per annum as significant factors for 30-day mortality. Kaplan-Meier, 1-year, 5-year, 10-year and 20-year survival were 85.2%, 77.1%, 70% and 59.3%, respectively. The conditional (post-30-day) survival was similar to the AVR cohort. CONCLUSIONS These Registry data provide a unique national insight into CVG outcomes. After a higher initial mortality risk, CVG has equivalent conditional longer-term survival to AVR.
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Affiliation(s)
- Maninder S Kalkat
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Edgbaston, Birmingham-B15 2TH, UK
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Zehr KJ, Orszulak TA, Mullany CJ, Matloobi A, Daly RC, Dearani JA, Sundt TM, Puga FJ, Danielson GK, Schaff HV. Surgery for Aneurysms of the Aortic Root. Circulation 2004; 110:1364-71. [PMID: 15313937 DOI: 10.1161/01.cir.0000141593.05085.87] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root. METHODS AND RESULTS Two-hundred three patients aged 53+/-16 years (mean+/-SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (P=NS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] = 88% to 97%), 79% (95% CI = 71% to 87%), 67% (95% CI = 57% to 79%), and 52% (95% CI = 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI = 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI = 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI = 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P< or =0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P< or =0.01). CONCLUSIONS Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.
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Affiliation(s)
- Kenton J Zehr
- Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, Minn 55905, USA.
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Kazui T, Yamashita K, Terada H, Washiyama N, Suzuki T, Ohkura K, Suzuki K. Late reoperation for proximal aortic and arch complications after previous composite graft replacement in marfan patients. Ann Thorac Surg 2003; 76:1203-7; discussion 1027-8. [PMID: 14530012 DOI: 10.1016/s0003-4975(03)00719-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Marfan patients who received composite graft replacement for proximal aortic disease frequently require late reoperation. The initial surgical technique for this lesion remains controversial. METHODS Fourteen Marfan patients who received composite graft replacement for annuloaortic ectasia with or without aortic dissection required late reoperation thorough re-median sternotomy. The techniques used for an initial composite graft replacement were the original Bentall procedure in 11 patients, the Cabrol procedure in 2, and coronary button technique in 1. Reoperation was indicated for prosthesis-related complications in 10 patients, distal aortic lesion in 13, or for both lesions in 8. Reoperations were performed, on average, 8.4 years after an initial operation. Reoperative procedures included re-composite graft replacement in 1 patient, total arch replacement in 5, and re-composite graft replacement with total arch replacement in 8. RESULTS There were two in-hospital deaths (14.3%). Although pseudoaneurysms of the coronary artery or distal aorta occurred in the original Bentall or Cabrol procedures, true aneurysms of the coronary artery were noted even in the coronary button technique. Six patients required a total of eight subsequent descending or thoracoabdominal aortic replacements for an aneurysmal formation of a distal false lumen. CONCLUSIONS The coronary button technique, with a small side hole for coronary anastomosis, is the procedure of choice for annuloaortic ectasia because it reduces the risk of coronary artery-related complications. Concomitant total arch replacement may be recommended for annuloaortic ectasia with DeBakey type I aortic dissection in selected patients to avoid the risk of reoperation on the aortic arch.
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Affiliation(s)
- Teruhisa Kazui
- First Department of Surgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan.
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11
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Milano AD, Pratali S, Mecozzi G, Boraschi P, Braccini G, Magagnini E, Bortolotti U. Fate of coronary ostial anastomoses after the modified Bentall procedure. Ann Thorac Surg 2003; 75:1797-801; discussion 1802. [PMID: 12822618 DOI: 10.1016/s0003-4975(03)00015-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Introduction of the modified Bentall procedure with the button technique has reduced but not eliminated anastomotic complications in patients receiving a composite aortic conduit. Particularly the true incidence of coronary ostial complications such as stenosis, kinking or pseudoaneurysm formation needs to be assessed. METHODS We reviewed 71 patients receiving a composite aortic conduit from November 1993 to November 1999 for chronic aneurysms (n = 51) or aortic dissection (n = 20), 12 of whom had Marfan syndrome. Patients were divided into two groups according to variations in the surgical technique. In group 1 (30 patients; 42%) the classic modified Bentall operation with the button technique was employed whereas in group 2 (41 patients; 58%) some technical modifications were added mainly consisting of a reinforcement suture joining the cut edge of the aortic wall and the prosthetic sewing ring and suture of the coronary buttons with an "endo-button" technique. To detect potential procedure-related complications particularly at the coronary ostia anastomoses follow-up included transthoracic two-dimensional echocardiography every 6 months and computerized tomographic angiography at 12 months or whenever indicated; in 20 patients a magnetic resonance imaging angiography and standard aortography with selective coronary angiography were also added. RESULTS At a mean follow-up of 49 +/- 19 months anastomotic complications occurred in 4 patients (6%): in 2 a pseudoaneurysm developed at the distal aortic suture line and in 1 a pseudoaneurysm developed at the right coronary ostium after repair of acute aortic dissection; in 1 Marfan patient an aneurysm of the left coronary ostium developed. Such complications were unrelated to the two surgical techniques used in this series for reimplantaion of the coronary ostia. CONCLUSIONS The modified Bentall operation is associated with an extremely low incidence of anastomotic complications particularly at the coronary ostia. More extensive use of new imaging techniques is desirable to assess the true incidence of such complications in patients receiving a composite aortic conduit.
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Affiliation(s)
- Aldo D Milano
- Division of Cardiac Surgery, Cardio-Thoracic Department, University of Pisa Medical School, Pisa, Italy
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Meijboom LJ, Nollen GJ, Merchant N, Webb GD, Groenink M, David TE, de Mol BAJM, Tijssen JGP, Romkes H, Mulder BJM. Frequency of coronary ostial aneurysms after aortic root surgery in patients with the Marfan syndrome. Am J Cardiol 2002; 89:1135-8. [PMID: 11988211 DOI: 10.1016/s0002-9149(02)02290-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lilian J Meijboom
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
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13
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Onoda K, Tanaka K, Yuasa U, Shimono T, Shimpo H, Yada I. Coronary artery aneurysm in a patient with Marfan syndrome. Ann Thorac Surg 2001; 72:1374-7. [PMID: 11603469 DOI: 10.1016/s0003-4975(00)02707-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
True aneurysm of the coronary artery in Marfan syndrome is very rare. We present a patient with Marfan syndrome who had aneurysms from the ascending aorta to the thoracoabdominal aorta and a large aneurysm of the left main coronary artery after an original Bentall operation. Prosthetic graft replacement of total aorta, coronary artery bypass grafting, and removal of the aneurysm of the left main coronary artery were successfully performed.
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Affiliation(s)
- K Onoda
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan.
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Fattori R, Descovich B, Bertaccini P, Celletti F, Caldarera I, Pierangeli A, Gavelli G. Composite graft replacement of the ascending aorta: leakage detection with gadolinium-enhanced MR imaging. Radiology 1999; 212:573-7. [PMID: 10429720 DOI: 10.1148/radiology.212.2.r99au02573] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the value of magnetic resonance (MR) imaging in the detection of postoperative complications after composite valve graft replacement. MATERIALS AND METHODS Spin-echo and gradient-echo MR imaging was performed in 52 patients 1/2 to 200 months after composite graft replacement of the ascending aorta (22 for dissection, 30 for aneurysm). The prosthetic aortic segment, distal and proximal anastomoses, general morphologic characteristics, and diameter of the reimplanted coronary arteries were evaluated. In patients with abnormal perigraft thickening, additional spin-echo imaging was performed after injection of gadopentetate dimeglumine. RESULTS Normal postoperative perigraft thickening (< or = 10 mm) was observed in 42 patients. Ten patients had abnormal periprosthetic thickening of 15-52 mm. Gadolinium-enhanced MR imaging demonstrated leakage in five of those 10 patients. The lack of enhancement excluded the presence of bleeding in the remaining five patients (three with chronic hematomas, one with infection, and one with granulation tissue). These findings were confirmed at surgery or with subsequent follow-up MR examinations. CONCLUSION MR imaging was an optimal imaging modality for evaluating the morphologic characteristics of composite grafts and reimplanted coronary arteries. Gadolinium-enhanced MR imaging is a simple, accurate, and noninvasive method for detecting a leak, which necessitates urgent repeat surgery.
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Affiliation(s)
- R Fattori
- Institute of Radiology and Cardiovascular Surgery, Ospedale S Orsola, Bologna, Italy.
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Greenberg R, Risher W. Clinical decision making and operative approaches to thoracic aortic aneurysms. Surg Clin North Am 1998; 78:805-26. [PMID: 9891578 DOI: 10.1016/s0039-6109(05)70352-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The care of the patient with thoracic aneurysms is quite complicated. The decision to treat an aneurysm must be based on the risk of rupture and the patient's life expectancy. The preoperative evaluation must include detailed imaging to allow proper preoperative planning. This is especially important to determine the need for hypothermic circulatory arrest or the potential to treat a descending aneurysm with an endovascular approach. Thorough preoperative preparation and intraoperative care are as important as surgical decision making and meticulous technique. Although significant advances have been made in operative approaches, cerebral and myocardial preservation, and postoperative care, the management of complicated aneurysms of the thoracic aorta is frequently a humbling experience.
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Affiliation(s)
- R Greenberg
- Department of Surgery, University of Rochester-Strong Memorial Hospital, New York, USA
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Affiliation(s)
- N T Kouchoukos
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Savunen T, Heikkilä H, Rantakokko V, Valtonen M, Vänttinen E. Acute dissection of ascending aortic aneurysm in a patient with previous coronary artery bypass grafting. Scand Cardiovasc J Suppl 1997; 31:161-3. [PMID: 9264165 DOI: 10.3109/14017439709058087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Six years after coronary artery bypass grafting, a 61-year-old man underwent emergency surgery for annulo-aortic ectasia and acute dissection. The aneurysmal tissue and aortic valve were excised and reconstruction was achieved with a composite graft. The patent vein grafts were attached to the composite graft and the original coronary orifices were closed.
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Affiliation(s)
- T Savunen
- Department of Surgery, Turku University Central Hospital, Finland
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