1
|
Li HY, Zhao YF, Dai L, Xu SJ, Zhang HJ, Jiang WJ. Ascending aortic dilation in adult patients with congenital ventricular septal defect: An observational study. Medicine (Baltimore) 2018; 97:e0383. [PMID: 29642196 PMCID: PMC5908605 DOI: 10.1097/md.0000000000010383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Many adult patients with congenital ventricular septal defect (VSD) also developed ascending aortic dilation, but few report the clinical features and surgical management of these patients. This study was designed to study ascending aortic dilation in adult patients with congenital VSD, and summarized the treatment experience and prognosis.To assess the clinical features and surgical management, we performed a retrospective analysis on preoperative data, intraoperative data, and postoperative data from the adult patients with congenital VSD who developed ascending aortic dilation in our institution from February 2010 to December 2016.From February 2010 to December 2016, we operated on 13 adult patients (12 males, 92.31%) with VSD who developed ascending aortic dilation. Median age was 37 (interquartile range 14) years. All patients suffered from perimembranous VSD and received surgical treatment. Their symptoms were all improved after surgery, no deaths occurred.Surgery is feasible for the ascending aortic dilation in adult patients with congenital VSD. Both proper perioperative treatment and close monitoring are required for the successful surgery.
Collapse
Affiliation(s)
- Hai-Yang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Yuan-Fei Zhao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Lu Dai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Shi-Jun Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Hong-Jia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Wen-Jian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| |
Collapse
|
2
|
Jiang WJ, Ma WG, Wang XL, Liu YY, Zhu JM, Sun LZ, Zhang HJ. Surgery for mitral regurgitation in patients with aortic root aneurysm: Transaortic or transseptal approach? Int J Cardiol 2016; 223:1059-1065. [PMID: 27623017 DOI: 10.1016/j.ijcard.2016.08.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Mitral regurgitation is common in patients with aortic root aneurysm. Mitral valve repair (MVP) or replacement (MVR) can be performed for these patients through either a transverse aortotomy (TA) or transseptal approach (TS). This study sought to compare the early outcomes of mitral valve surgery through the TA and TS approaches and decide which is optimal for this subset of patients. METHODS Between March 2013 and April 2015, we operated on 99 patients (81 males, 81.8%) with aortic root aneurysm who developed mitral regurgitation. Mean age was 47.8±16.5years. MVR was performed in 66 patients (TAR=27; TSR=39) and MVP in 33 (TAP=8; TSP=25). The baseline and operative outcomes data were compared between patients with MVR and MVP through the TA vs TS approaches. RESULTS Preoperatively, the mitral regurgitation area was significantly larger in the MVR than MVP groups (8.9±2.0 vs 7.8±3.8 cm2, p=0.0009), and in the TSP vs TAP groups (8.5±4.1 vs 5.6±1.3cm2, p=0.0049), but no significant difference was found between the TAR and TSR groups (8.7±2.2 vs 9.0±1.8cm2, p=0.4681); the aortic sinus size was significantly larger in the TAR than TSR group (66.7±15.8 vs 52.1±8.8mm, p=0.0061). Subvalvular structure was preserved in 12 MVR patients (18.2%). In MVP patients, Kay annuloplasty was used in 11 (33.3%) and annuloplastic ring in 22 (66.7%). The times of cardiopulmonary bypass (CPB) and cross-clamp in patients with TA approach were significantly shorter compared to those with the TS approach (139±34 vs 176±38min, p=0.0001; 101±26 vs 129±31min, p=0.0002). No cases of mortality, stroke and renal failure occurred in the whole series. The amount of transfusion, lengths of ICU and hospital stay did not differ between patients with MVR and MVP, and between the TA and TS approaches. CONCLUSIONS Both the TA and TS approaches achieved good early outcomes in MV surgery for patients with root aneurysm. The transverse aortotomy was associated with shorter CPB and cross-clamp times. Surgical approaches should be selected according to the underlying mitral valve etiology and the size of the aortic root.
Collapse
Affiliation(s)
- Wen-Jian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Beijing Lab for Cardiovascular Precision Medicine, Beijing, China; Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China; Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China; Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Beijing Lab for Cardiovascular Precision Medicine, Beijing, China; Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China; Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China; Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Xiao-Long Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Beijing Lab for Cardiovascular Precision Medicine, Beijing, China; Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China; Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China; Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Yu-Yong Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Beijing Lab for Cardiovascular Precision Medicine, Beijing, China; Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China; Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China; Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Jun-Ming Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Beijing Lab for Cardiovascular Precision Medicine, Beijing, China; Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China; Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China; Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Beijing Lab for Cardiovascular Precision Medicine, Beijing, China; Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China; Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China; Beijing Engineering Research Center for Vascular Prostheses, Beijing, China.
| | - Hong-Jia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Beijing Lab for Cardiovascular Precision Medicine, Beijing, China; Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China; Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China; Beijing Engineering Research Center for Vascular Prostheses, Beijing, China.
| |
Collapse
|