1313 Unusual Supraannular Aortic Root Intimal Tear in a Patient with Severe Aortic Regurgitation

Abstract We present an extremely rare case of occult supraannular aortic root intimal tear in a patient presenting with acute severe aortic regurgitation (AR) and a previously undiagnosed bicuspid aortic valve. A 41-year-old Africo-Carribean female presented to the emergency department with acute pulmonary oedema and increasing dyspnea on exertion. She had been treated empirically with antibiotics for a chest infection. Initial concerns were either aortic dissection or infective endocarditis. Transthoracic echocardiography (TTE) demonstrated a normal size left ventricle with hyperdynamic systolic function and severe AR. The patient was transferred to a tertiary cardiothoracic surgical centre for urgent surgical treatment in view of haemodynamic instability and acute AR. A gated computed tomography aortogram identified pulmonary oedema with an asymmetrically dilated aortic root (maximal diameter 45 mm). Despite advanced multimodality preoperative imaging, diagnosis was made intraoperatively and prompted Bentall procedure with mechanical aortic valve. After median sternotomy and initiation of cardiopulmonary bypass, a supraannular aortic intimal tear starting from the right coronary cusp/noncoronary cusp commissure was found with no extension into the aorta. The aortic valve was bicuspid and severe AR not amenable to repair was found. Bentall procedure was performed using the 23/26mm Carbomedics Carbo Seal Valsalva composite graft (Sulzer Carbomedics Inc, Austin, TX, USA). The patient was discharged on the 7th postoperative day in sinus rhythm. At 30-day clinical follow-up she was symptom free with a satisfactory TTE.

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Sleeve Technique Combined With Aortic Valve Replacement: A Simpler Alternative to the Bentall Procedure

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520967019 ◽

2020 ◽

pp. 155698452096701

Author(s):

Giuseppe De Cicco ◽

Ana Paula Tagliari ◽

Gerardo Di Matteo ◽

Francesco Trinca ◽

Fabrizio Rosati ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Aortic Root ◽

Surgical Techniques ◽

Root Disease ◽

Severe Aortic Regurgitation ◽

Bentall Procedure ◽

Aortic Root Disease

Aortic root disease can be treated with different surgical techniques. The surgical approach of choice depends on patients’ comorbidities and aortic valve conditions. We describe an operation combining a Sleeve aortic rootplasty with an aortic valve replacement, as an alternative to the classical Bentall procedure. The patient, a 63-year-old man, was admitted to our institution in April 2019 with severe aortic regurgitation, left ventricle dysfunction (ejection fraction = 44%), and aortic root ectasia (476 mm). Since a sparing aortic valve procedure was judged not feasible because of the thickness and retraction of the leaflets, we decided to perform a procedure through a sleeve operation to treat the aortic ectasia and a standard bioprosthetic aortic valve replacement to treat the aortic regurgitation. The patient had an uneventful postoperative course and was discharged on the sixth postoperative day with aspirin as sole antiplatelet treatment. This procedure may be considered an alternative to the Bentall operation. In fact, it may also offer complete treatment for the aortic root disease, avoiding coronary complications due to coronary ostia manipulation and reimplantation.

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Subtle Aortic Dissection in a Patient with Severe Aortic Regurgitation and Undiagnosed Bicuspid Aortic Valve: Case Report with a Literature Review

10.22541/au.161825143.36757661/v1 ◽

2021 ◽

Author(s):

Davorin Sef ◽

Stewart Brown ◽

Omar Jarral ◽

Azhar Hussain ◽

Elizabeth Haslam ◽

...

Keyword(s):

Aortic Valve ◽

Literature Review ◽

Aortic Dissection ◽

Aortic Regurgitation ◽

Bicuspid Aortic Valve ◽

Current Data ◽

Preoperative Imaging ◽

Severe Aortic Regurgitation ◽

Bentall Procedure ◽

Dismal Prognosis

A subtle aortic dissection can be challenging to detect despite the availability of multiple diagnostic modalities. Whilst rare, the inability to detect this variant of aortic dissection can lead to a dismal prognosis. We present an extremely rare case of a subtle aortic dissection with supraannular aortic root intimal tear and acute severe aortic regurgitation in a patient with a bicuspid aortic valve. Initial concerns were either aortic dissection or infective endocarditis. Despite advanced multimodality preoperative imaging, diagnosis was made intraoperatively and a Bentall procedure with a mechanical aortic valve was performed. As current data is limited, a literature review concerning subtle aortic dissection is provided.

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Emergency aortic root replacement with the Bioconduit stentless aortic valve conduit

ROMANIAN BIOTECHNOLOGICAL LETTERS ◽

10.25083/rbl/25.6/2055.2059 ◽

2020 ◽

Vol 25 (6) ◽

pp. 2055-2059

Author(s):

ADRIAN TULIN ◽

◽

OVIDIU STIRU ◽

MIRUNA LUANA MIULESCU ◽

LAURA RADUCU ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Aortic Root ◽

Aortic Root Replacement ◽

Bentall Operation ◽

Severe Aortic Regurgitation ◽

Valve Conduit ◽

Successful Case ◽

Valved Conduit

This report concerns a 73-year-old woman who presented with asymptomatic aortic root an-eurysm with severe aortic regurgitation. The purpose of this article is to present our first successful case for emergency aortic root replacement (Bentall operation) that involves annular implantation of a pericardial valved conduit (Bioconduit TM, Biointegral Surgical, Inc., Ontario, Canada) and to discuss some essential technical clue issues related to this approach.

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Bicuspid Aortic Valve Associated with Severe Aortic Regurgitation and Large Aortic Root Aneurysm

Cureus ◽

10.7759/cureus.7321 ◽

2020 ◽

Author(s):

Alejandro Sanchez-Nadales ◽

Miguel Treminio Quezada ◽

Valentina Celis ◽

Jessica Navarro

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Severe Aortic Regurgitation ◽

Aortic Root Aneurysm

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Evolution into Takayasu arteritis in a patient presenting with acute pulmonary oedema due to severe aortic regurgitation; a case report

BMC Rheumatology ◽

10.1186/s41927-018-0028-5 ◽

2018 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Nipun Lakshitha de Silva ◽

Milinda Withana ◽

Praveen Weeratunga ◽

Prakash Priyadharshana ◽

Inoshi Atukorala

Keyword(s):

Case Report ◽

Pulmonary Oedema ◽

Aortic Regurgitation ◽

Takayasu Arteritis ◽

Acute Pulmonary Oedema ◽

Severe Aortic Regurgitation

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Valve-sparing aortic root replacement and remodeling with complex aortic valve reconstruction in children and young adults with moderate or severe aortic regurgitation

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2014.02.055 ◽

2014 ◽

Vol 147 (6) ◽

pp. 1768-1776 ◽

Cited By ~ 11

Author(s):

Patrick O. Myers ◽

Pedro J. del Nido ◽

Sitaram M. Emani ◽

Gerald R. Marx ◽

Christopher W. Baird

Keyword(s):

Young Adults ◽

Aortic Valve ◽

Aortic Regurgitation ◽

Aortic Root ◽

Aortic Root Replacement ◽

Severe Aortic Regurgitation ◽

Valve Reconstruction ◽

Children And Young Adults ◽

Valve Sparing

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Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽

10.1024/0301-1526.34.3.181 ◽

2005 ◽

Vol 34 (3) ◽

pp. 181-185 ◽

Cited By ~ 12

Author(s):

Westhoff-Bleck ◽

Meyer ◽

Lotz ◽

Tutarel ◽

Weiss ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Aortic Valve ◽

Pulmonary Artery ◽

Aortic Arch ◽

Thoracic Aorta ◽

Aortic Root ◽

Ascending Aorta ◽

Descending Aorta ◽

Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

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