Partial aortic root replacement for aneurysm of the right sinus of Valsalva

A bicuspid aortic valve sometimes coincides with a sinus of Valsalva aneurysm having a coronary artery anomaly. A meticulous aortic root replacement strategy is needed in these cases. In a 64-year-old man, the left coronary arteries (LCA) with an aberrant origin were excised together and reattached to the side hole of a valved conduit via a short Dacron graft. To prevent the formation of an aneurysm at the site, a strip of Dacron graft was sutured from outside between the LCA. The procedure for aortic root replacement with a coronary anomaly needs a case-by-case surgical strategy.

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How We Perform a David Procedure With an Upper Hemisternotomy Approach

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/15569845211045965 ◽

2021 ◽

Vol 16 (6) ◽

pp. 545-552

Author(s):

Vishal N. Shah ◽

Maxwell F. Kilcoyne ◽

Meghan Buckley ◽

Oleg I. Orlov ◽

Serge Sicouri ◽

...

Keyword(s):

Aortic Root ◽

Systematic Approach ◽

Aortic Root Replacement ◽

Seldinger Technique ◽

Venous Cannulation ◽

Aortic Cross Clamp ◽

Hospital Stays ◽

Perioperative Safety ◽

The Right ◽

Fourth Intercostal Space

Objective Valve-sparing aortic root replacement (David procedure) is the technique of choice in appropriately selected patients with aortic root aneurysms. These procedures are seldom performed in a minimally invasive fashion. We describe our systematic approach to the David procedure using an upper hemisternotomy (UHS). Methods: Our method involves a J-type UHS exiting the right third or fourth intercostal space. Ascending aortic and femoral venous cannulation are performed using the Seldinger technique under transesophageal echocardiographic guidance. Between August 2005 and August 2014, 27 patients underwent an isolated elective David procedure using a full sternotomy (FS). Sixteen underwent an isolated elective UHS David procedure from May 2015 to February 2019. Perioperative safety outcomes were compared between the 2 cohorts. Results: The UHS and FS David cohorts were primarily male (87.5% and 85.2%, respectively) and 51 and 50 years old on average, respectively. Custodiol-histidine-tryptophan-ketoglutarate cardioplegia (93.8% vs 37.0%, P < 0.001) and Cor-Knot (100% vs 0%, P < 0.001) were used significantly more in the UHS David cohort. There were no significant differences in cardiopulmonary bypass (200 [183–208] vs 212 [183–223] min, P = 0.309) and aortic cross-clamp (169 [155–179] vs 188 [155–199] min, P = 0.128) times in the UHS and FS cohorts. There were no instances of hospital or 30-day mortality in either cohort. Intensive care unit and hospital stays were comparable between the 2 cohorts. Conclusions: The David procedure via UHS is a safe and reproducible technique for aortic root replacement.

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Repair of a Unique Sinus of Valsalva Defect in an Infant

10.22541/au.161211868.85925785/v1 ◽

2021 ◽

Author(s):

Satoshi Okugi ◽

Masaaki Koide ◽

Yoshifumi Kunii ◽

Minori Tateishi ◽

Risa Shimbori ◽

...

Keyword(s):

Right Ventricular ◽

Aortic Root ◽

Right Ventricular Outflow Tract ◽

Ventricular Myocardium ◽

Ventricular Outflow Tract ◽

Sinus Of Valsalva ◽

Direct Closure ◽

Sinus Of Valsalva Aneurysm ◽

Intracardiac Repair ◽

The Right

Sinus of Valsalva aneurysm is a rare disease characterized by the partial elevation of the aortic root. Few reports are available on the surgical treatment for infants. We report the repair of an extremely rare case of a sinus of Valsalva defect with a ventricular septal defect and right ventricular outflow tract stenosis in an infant. It was not a sinus of Valsalva aneurysm, but it exhibited abnormal partial bulging of the aortic root and forming an aneurysm-like cavity within the right ventricular myocardium. We performed direct closure of the sinus of Valsalva aneurysm-like cavities and intracardiac repair in two stages. Three years after total repair, the patient remained healthy and asymptomatic.

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