Valve Surgery to Treat Connective Tissue Disease: Comparison Between Valve Replacement and Aortic Root Replacement

Pseudoaneurysms of the mitral-aortic intervalvular fibrosa are rare complications that can develop after mitral or aortic valve surgery, endocarditis, or Takayasu arteritis. The optimal timing of surgery to avoid potentially life-threatening complications of pseudoaneurysms has not been established, and watchful waiting has been adopted in specific situations. We describe the case of a 50-year-old man in whom a pseudoaneurysm of the mitral-aortic intervalvular fibrosa developed after aortic root replacement with a homograft. After 13 years of watchful waiting, reoperation was deemed necessary because the pseudoaneurysm had grown to 48 mm and the aortic regurgitation caused by the degenerated homograft had become severe. This case highlights the need for increased awareness of mitral-aortic intervalvular fibrosa pseudoaneurysms and their management.

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Aortic Root Enlargement during Aortic Valve Replacement in Adults

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/21.4512/fv059-5662 ◽

2021 ◽

pp. 56-62

Author(s):

Miroslav M. Furman ◽

Sergey V. Varbanets ◽

Oleksandr M. Dovgan

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Severe Aortic Stenosis ◽

Aortic Root Replacement ◽

Safe Procedure ◽

Aortic Pathology ◽

Aortic Root Enlargement

Aortic valve replacement is a gold standard in the treatment of patients with severe aortic stenosis or combined aortic pathology. However, aortic valve pathology is often associated with a narrow aortic orifice, particularly in patients with severe aortic stenosis. In 1978, Rahimtoola first described the term of prosthesis-patient mismatch. He noted that effective orifice area of the prosthesis is smaller than that of the native valve. To minimize this complication, there are several surgical strategies: aortic root enlargement (ARE), implantation of a frameless biological prosthesis in the native position, neocuspidalization procedure, Ross procedure, aortic root replacement with xenograft or homograft. ARE is an excellent option, however, some authors outline additional perioperative risks. The aim. To analyze immediate results of ARE during isolated aortic valve replacement and in cases when it is combined with other heart pathologies. Materials and methods. Our study included 63 patients who underwent ARE. Isolated aortic valve replacement was performed in the majority of cases, but often aortic root replacement procedure was combined with coronary artery bypass grafting. Results and discussion. One of 63 patients died (hospital mortality 1.6%) at an early hospital stage (30 postoperative days). Measurement of the aortic valve ring was performed by two methods, through preoperative echocardiography and perioperative measurement using a valve sizer. However, perioperative dimension was chosen as the basis for the calculations. In 62 patients, the perioperative diameter of the aortic valve ring ranged from 19 to 23 mm, only one patient had a diameter of 24 mm. According to our findings, ARE enabled to achieve an average aortic ring size increase of 2.68 cm2 (from 1.5 to 3.4 cm2) and to prevent prosthesis-patient mismatch in 42 (66.7%) cases. Conclusions. Prosthesis-patient mismatch is considered a serious complication in the postoperative period. Narrow aortic root is a common pathology that should be considered during surgery. ARE is a safe procedure and is not associated with an increased risk of mortality and complications.

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Aortic Root Dimensions and Pulse Wave Velocity in Young Competitive Athletes

Journal of Clinical Medicine ◽

10.3390/jcm10245922 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5922

Author(s):

Tobias Engl ◽

Jan Müller ◽

Patrick Fisel ◽

Renate Oberhoffer-Fritz

Keyword(s):

Cardiovascular Risk ◽

Connective Tissue ◽

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Connective Tissue Disease ◽

Wave Velocity ◽

Aortic Root ◽

Pulse Wave ◽

Young Athletes ◽

Aortic Root Dilatation

The assessment of aortic root dimensions is a cornerstone in cardiac pre-participation screening as dilation can result in severe cardiac events. Moreover, it can be a hint for an underlying connective tissue disease, which needs individualized sports counseling. This study examines the prevalence of aortic root dilatation in a cohort and its relationship to arterial stiffness as an early marker of cardiovascular risk due to vascular aging. From May 2012 to March 2018, we examined 281 young male athletes (14.7 ± 2.1 years) for their aortic root dimension. Moreover, we noninvasively assessed arterial stiffness parameter during pre-participation screening. Mean aortic diameter was 25.9 ± 3.1 mm and 18 of the 281 (6.4%) athletes had aortic root dilation without other clinical evidence of connective tissue disease. After adjusting for BSA, there was no association of aortic root diameter to pulse wave velocity (p = −0.054 r = 0.368) nor to central blood pressure (p = −0.029 r = 0.634). Thus, although a significant proportion of young athletes had aortic root dilatation, which certainly needs regular follow up, no correlation with arterial stiffness was found. It could be suggested that a dilated aortic root in young athletes does not alter pulse waveform and pulse reflection, and thus there is no increased cardiovascular risk in those subjects.

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Repair of Aortic Regurgitation due to Takayasu Arteritis

The Heart Surgery Forum ◽

10.1532/hsf98.20121059 ◽

2013 ◽

Vol 16 (1) ◽

pp. 24 ◽

Cited By ~ 4

Author(s):

ChengNan Li ◽

YongMin Liu ◽

RuiDong Qi ◽

Jun Zheng ◽

JunMing Zhu ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Takayasu Arteritis ◽

Aortic Root ◽

Aortic Root Replacement ◽

Takayasu Disease ◽

Valve Detachment

Background: Prosthetic valve detachment after aortic valve replacement and pseudoaneurysm formation are the most important postoperative complications in patients with Takayasu arteritis with aortic regurgitation. We reviewed our experience of surgical treatment of aortic regurgitation in patients with Takayasu disease.Methods: Between November 1997 and September 2011, 11 patients (4 women and 7 men) with Takayasu arteritis with aortic regurgitation underwent surgical treatment. The age of the patients ranged from 26 to 56 years (mean, 40 � 9 years). Primary isolated aortic valve replacement was performed in 1 patient, David procedure in 1 patient, Wheat procedure in 1 patient, Bentall procedure in 2 patients, and Cabrol procedure in 6 patients (including 2 patients who underwent primary aortic valve replacement in other hospitals before being admitted to our surgical team).Results: There was no in-hospital death. All patients had an uneventful recovery during the postoperative course and were discharged. Prosthetic valve detachment, pseudoaneurysm formation at the suture line, and dilatation of the ascending aorta were not found in patients with composite aortic root replacement during a mean follow-up of 98 � 45 months. One patient died during follow-up.Conclusion: Valve detachment after composite aortic root replacement was not observed in patients with Takayasu disease with aortic regurgitation. Satisfactory surgical outcomes were obtained using composite aortic root replacement. However, close follow-up was needed to assess the effectiveness of the Cabrol procedure in patients with Takayasu disease with aortic regurgitation.

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Case 7.27

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0188 ◽

2014 ◽

pp. 357-358

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Cardiac Failure ◽

Aortic Root ◽

Aortic Root Replacement ◽

Prosthetic Aortic Valve

72-year-old man with aortic dissection who underwent aortic root replacement and prosthetic aortic valve replacement 14 years ago; the patient has had worsening periprosthetic regurgitation and cardiac failure and has required multiple transfusions Two axial GRE images from a BOLD acquisition (Figure 7.27.1...

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