scholarly journals Surgical treatment of ascending aortic dissection(DeBakey type I) with aortic regurgitation: Replacement of the ascending aorta and resuspension of the aortic valve.

1989 ◽  
Vol 18 (5) ◽  
pp. 671-673
Author(s):  
M. Tanaka
Keyword(s):  
Surgical Treatment ◽  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Ascending Aorta ◽  
Type I

Predictors of Proximal Aortic Dissection at the Time of Aortic Valve Replacement

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Yskert von Kodolitsch ◽  
Ognjen Simic ◽  
Ann Schwartz ◽  
Christoph Dresler ◽  
Roger Loose ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Aortic Surgery ◽  
Separate Analysis ◽  
Type I ◽  
Valve Prostheses

Background —Type I aortic dissection develops in 0.6% of patients late after aortic valve replacement (AVR), and 13% of patients with type I aortic dissections have a history of AVR. Predictors of aortic dissection at AVR, however, have not been characterized. Methods and Results —A study group of 33 patients with type I aortic dissection had aortic surgery 49±55 months after routine AVR. A group of 101 controls, who did not have morphological progression of aortic diameters ≥6 years after AVR, was used to identify predictors of postsurgical dissection. Multivariate analysis identified aortic regurgitation ( P <0.002) and fragility ( P <0.001) or thinning of the aortic wall ( P <0.007) at AVR as predictors, associated with a 14%, 22%, and 7% probability of late aortic dissection, respectively. Clamping times, types of valve prostheses, concomitant coronary artery bypass grafting, and mean ascending aortic diameters of 43±10 mm at AVR did not predict late dissection. A separate analysis of 29 nondissecting aneurysms of the ascending aorta developing 104±64 months after routine AVR revealed younger age at AVR ( P <0.003) and congenitally bicuspid aortic valves ( P <0.03) as predictors of late aneurysm formation. Conclusions —Aortic regurgitation combined with fragile and thinned aortic walls in patients with moderate aortic dilation may reflect aortic root disease, with a high risk for postsurgical aortic sequelae if it is treated incompletely by isolated valve replacement.

scholarly journals Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency

2016 ◽  
Vol 20 (2) ◽  
pp. 35 ◽  
Author(s):  
M. L. Gordeev ◽  
V. E. Uspenskiy ◽  
G. I. Kim ◽  
A. N. Ibragimov ◽  
T. S. Shcherbinin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Type A ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Sparing

<p><strong>Aim:</strong> The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.<br /><strong>Methods:</strong> From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11), combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12), and Bentall procedure (group 3, n = 26). We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement.<br /><strong>Results:</strong> The hospital mortality rate was 8.2% (4/49 patients). The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period.<br /><strong>Conclusions:</strong> Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long-term follow-up is needed.</p><div class="well well-small"><strong>Funding</strong></div><p><strong></strong> The study has been performed within the framework of the 2015-2017 government task, “Cardiovascular diseases” platform, Theme No. 4 Research on genome/cellular mechanisms responsible for aorta/aortic valve pathology development and elaboration of new methods of its multimodality treatment including hybrid technologies.<br /><strong></strong></p><p><strong>Conflict of interest</strong></p><p><strong></strong>The authors declare no conflict of interest.</p><p><strong>Acknowledgement</strong></p><p>The authors express their deep gratitude for assistance in diagnostics and management of patients with aortic pathologies, as well as in preparation of this article to A.Yu. Bakanov, PhD, Head of Research Laboratory of Perfusiology and Cardiac Protection; V.V. Volkov, Fellow of Research Laboratory of Perfusiology and Cardiac Protection; A.V. Naymushin, PhD, Head of Anesthesiology &amp; Resuscitation/ICU-2 Department; I.V. Basek, Phd, Head of X-Ray Computer Tomography Department and the specialists of X-Ray Computer Tomography Department, as well as to the employees of Research Center for Non-Coronary Heart Diseases and to specialists of cardiovascular surgery departments.</p>

scholarly journals REDO-BENTALL OPERATION – ITERATIVE AORTIC ROOT RECOSTRUCTION – THERAPEUTIC DECISION-MAKING COMPLEXITY AND PROCEDURAL COMPLEXITY

2018 ◽  
Vol 1 (2) ◽  
pp. 67-70
Author(s):  
Celia Ciobanu ◽  
C. Voica ◽  
B. Rădulescu ◽  
H. Moldovan
Keyword(s):  
Decision Making ◽  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Ascending Aorta ◽  
Type I ◽  
Therapeutic Decision ◽  
Bentall Operation ◽  
Therapeutic Decision Making

We present the case of a 59-year-old woman who undergoes surgery 12 years after the Bentall-de Bono operation (replacement of the aortic valve and ascending aorta with valvular duct and direct reimplantation of the coronaryan ostia in the duct). For the acute aortic dissection of type I De Bakey (Stanford type A), diagnosed with subacute infectious endocarditis at the level of the aortic valvular duct with abscess in the aortic root.

Abstract 2137: Bicuspid Aortic Valve, Aortic Dissection And Sudden Death In The Young: Just A Matter Of Ascending Aorta Diameters?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Cristina Basso ◽  
Stefano Nistri ◽  
Stefania Rizzo ◽  
Aierkeen Abudureheman ◽  
Gaetano Thiene
Keyword(s):  
Aortic Valve ◽  
Sudden Death ◽  
Aortic Dissection ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Type I ◽  
Tunica Media ◽  
Structural Abnormalities ◽  
Medial Necrosis

Background. Although bicuspid aortic valve (BAV) may remain silent during life, it can announce dramatically with aortic dissection and sudden death. The aim of the study was to determine the aortic diameters and histopathologic background in young people with BAV and aortic dissection. Design. Among 449 cardiovascular sudden deaths in the young (<35 years), 15 (3.3%), mean age 27±6.6, 14 M/1F, had a mechanical cardiac arrest due to aortic dissection (type I: 7, type II: 6, type III: 2): 6 had isolated BAV, 2 BAV associated with coarctation, 2 Marfan syndrome, 1 coarctation, 1 pregnancy, 1 hypertension and 2 were idiopathic. Ten young BAV patients who died suddenly without aortic dissection and 10 sex and age-matched controls were considered for comparison. Aortic root was measured at 4 levels (A1, annulus; A2, sinuses of Valsalva, A3, supraaortic ridge and A4, proximal ascending aorta). Histopathologic evaluation of the aortic tunica media was performed to assess elastic fragmentation, disarray, medial necrosis, proteoglycans deposits and fibrosis. Results. Aortic diameter values in dissected BAV vs normal BAV vs controls were: A1, 30.7±2.0 vs 27.4±2.3 (p=0.05) vs 26.3±1.6 (p<0.001); A2, 35.0±5.2 vs 28.9±1.8 (p=0.01) vs 27.3±1.5 (p=0.003); A3, 32.5±5.8 vs 26.7±2.5 (p=0.03) vs 24.5±1.5 (p=0.003); and A4, 38.7±7.0 vs 26.6±3.4 (p=0.002) vs 23.9±1.8 (p<0.001). Aortic diameters were significantly higher in Marfan patients (A1, 34.4±2.7; A2, 44.9±4.0; A3, 45.8±5.4; A4, 46.4±1.9). When comparing BAVs with and without dissection, higher scores of medial necrosis (1.2±0.4 vs 0.2±0.5, p=0.01), elastic fragmentation (2.4±0.5 vs 0.7±0.5, p=0.001) and fibrosis (1.6±0.5 vs 0.2±0.5, p=0.004) were found. Moreover, when comparing dissected BAVs and Marfan patients, similar structural abnormalities were found except lower medial necrosis (1.2±0.4 vs 2±0.0, p=0.002). Conclusions. Aortic root diameters are lower in dissected BAV than Marfan patients. However, structural abnormalities of the tunica media in terms of elastic fragmentation and fibrosis are similar. Imaging techniques able to assess not only a progressive increase of aortic diameters, but also abnormal aortic elasticity and stiffness are warranted to indentify patients at risk of aortic dissection.

Health-related quality of life one year after surgical treatment of the type I chronic aortic dissection

2019 ◽  
Vol 38 (1) ◽  
Author(s):  
Oksana Kamenskaya ◽  
Asya Klinkova ◽  
Irina Loginova ◽  
Alexander Chernyavskiy ◽  
Dmitry Sirota ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Aortic Dissection ◽  
Type I ◽  
Health Related Quality ◽  
Chronic Aortic Dissection ◽  
Related Quality ◽  
Health Related ◽  
One Year

Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

2016 ◽  
Vol 24 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Tilo Kölbel ◽  
Christian Detter ◽  
Sebastian W. Carpenter ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Open Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Type I ◽  
Acute Type ◽  
Stent Grafts ◽  
Type A Aortic Dissection ◽  
Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

scholarly journals Surgical Treatment of Acute Type A Aortic Dissection with 18-Litre Bleeding

Aorta ◽  
2021 ◽  
Vol 09 (01) ◽  
pp. 030-032
Author(s):  
Sergey Y. Boldyrev ◽  
Kirill O. Barbukhatty ◽  
Vladimir A. Porhanov
Keyword(s):  
Surgical Treatment ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Type I ◽  
Acute Type ◽  
Drug Induced ◽  
Type A Aortic Dissection ◽  
Mortality And Morbidity ◽  
Perioperative Bleeding

AbstractSurgical treatment of Type-A acute aortic dissection is associated with high mortality and morbidity. One of the reasons is perioperative bleeding, which may lead to worse outcomes. We present a case of successful treatment of a patient with 18-litre perioperative blood loss in DeBakey Type-I acute aortic dissection with drug-induced hypocoagulation and malperfusion of a lower extremity.

scholarly journals Surgical treatment of aneurysms of the ascending aorta associated with severe aortic regurgitation.

Thorax ◽  
1984 ◽  
Vol 39 (4) ◽  
pp. 305-310 ◽  
Author(s):  
M J Antunes ◽  
A L Baptista ◽  
P R Colsen ◽  
R H Kinsley
Keyword(s):  
Surgical Treatment ◽  
Aortic Regurgitation ◽  
Ascending Aorta ◽  
Severe Aortic Regurgitation

scholarly journals P190 Chest pain and syncope in Turner"s syndrome: going beyond the obvious to not miss the critical diagnosis. Role of multimodality imaging approach

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Ruocco ◽  
M Previtero ◽  
N Bettella ◽  
D Muraru ◽  
S Iliceto ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pericardial Effusion ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Dissection ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Rule Out ◽  
Typical Chest Pain

Abstract Clinical Presentation: a 18-year-old woman with Turner’s syndrome (TS), with history of hypothyroidism treated with L-thyroxin, asymptomatic moderately stenotic bicuspid aortic valve (AV) and without any known cardiovascular risk factor, was admitted to our emergency department (ED) because of syncope and typical chest pain after dinner associated with dyspnea. Chest pain lasted for an hour with spontaneous regression. In the ED the patient (pt) was normotensive. An ECG showed sinus rhythm (88 bpm), nonspecific repolarization anomalies (T wave inversion) in the inferior and anterior leads. Myocardial necrosis biomarkers were negative. A 3D transthoracic echocardiography showed normal biventricular systolic function with left ventricular hypertrophy, dilatation of the ascending aorta, unicuspid AV with severe aortic stenosis (peak/mean gradient 110/61 mmHg, aortic valve area 0,88 cm2-0,62 cm2/m2), mild pericardial effusion (Figure Panel A, B, C). Five days after, the pt had a new episode of typical chest pain without ECG changes. A computerized tomography (CT) was performed to rule out the hypothesis of aortic dissection and showed a dilation of the ascending aorta and pericardial effusion localized in the diaphragmatic wall, no signs of dissection or aortic hematoma. However, CT was of suboptimal quality because of sinus tachycardia (120 bpm) and so the pt underwent a coronary angiography and aortography that ruled out coronary disease, confirmed the dilatation of ascending aorta (50 mm) and showed images of penetrating atherosclerotic ulcer of the ascending aorta (Figure panel D). The pt underwent urgent transesophageal echocardiography (TOE) that confirmed the severely stenotic unicuspid AV and showed a localized type A aortic dissection (Figure Panel E, F, G). The pt underwent urgent AV and ascending aorta replacement (Figure Panel H). Learning points Chest pain and syncope are challenging symptoms in pts presenting in ED. AV pathology and aortic dissection should be always suspected and ruled out. TS is associated with multiple congenital cardiovascular abnormalities and is the most common established cause of aortic dissection in young women. 30% of Turner’s pts have congenitally AV abnormalities, and dilation of the ascending aorta is frequently associated. However, unicuspid AV is a very rare anomaly, usually stenotic at birth and requiring replacement. The presence of pericardial effusion in a pt with chest pain and syncope should raise the suspicion of aortic dissection, even if those symptoms usually accompany severe aortic stenosis. Even if CT is the gold standard imaging technique to rule out aortic dissection, the accuracy of a test is critically related to the image quality. When the suspicion of dissection is high and the reliability of the reference test is low, it’s reasonable to perform a different test to rule out the pathology. Aortography and TOE were pivotal to identify the limited dissection of the ascending aorta. Abstract P190 Figure.

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