Surgical Experience with Doty's Repair for Supravalvular Aortic Stenosis

1996 ◽  
Vol 4 (1) ◽  
pp. 29-32
Author(s):  
Balram Airan ◽  
Sunil K Kaushal ◽  
Anil Bhan ◽  
Panangipalli Venugopal
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Coronary Sinus ◽  
Innominate Artery ◽  
Left Ventricular ◽  
Supravalvular Aortic Stenosis ◽  
Coarctation Of Aorta ◽  
Valve Function ◽  
Aortic Obstruction ◽  
The Right

The surgical treatment of severe supravalvular aortic stenosis by conventional, asymmetrical, one point patch aortoplasty across the narrowed area has been associated with a substantial incidence of residual stenosis and reoperations. Almost symmetrical relief of such stenosis was achieved with Doty's extended aortoplasty in 5 patients in whom left ventricular aortic gradient was reduced from 60–170 nun Hg to 0–25 mm Hg. This technique of inserting an inverted V-shaped gusset across the stenosed segment into the right coronary sinus and non-coronary sinus, restores the aortic root geometry, provides more predictable relief of aortic obstruction and also improves aortic valve function. Associated procedures involved relief of coarctation of aorta and innominate artery stenosis in 1 case and repair of aortic valve and mitral valve in another case.

scholarly journals Avoidance of malignant arrhythmia caused by displacement of the right coronary artery ostium in surgical correction of supravalvular aortic stenosis

2019 ◽  
Vol 47 (11) ◽  
pp. 5702-5710
Author(s):  
Bo Peng ◽  
Qiang Wang
Keyword(s):  
Coronary Artery ◽  
Aortic Stenosis ◽  
Right Coronary Artery ◽  
Coronary Sinus ◽  
Surgical Techniques ◽  
Ecmo Support ◽  
Supravalvular Aortic Stenosis ◽  
Surgical Approaches ◽  
Malignant Arrhythmia ◽  
The Right

Objective This study was performed to identify the effects of different surgical approaches on the right coronary artery ostium in patients with congenital supravalvular aortic stenosis (SVAS) and to determine how to avoid surgically induced right coronary artery occlusion. Methods The surgical techniques and outcomes of 91 patients who underwent surgical treatment of SVAS from 2008 to 2015 in our institution were retrospectively reviewed to identify the causes of early death, reoperation, and extracorporeal membrane oxygenation (ECMO) support. Results Four perioperative deaths (Doty’s technique, n = 4), six cases of ECMO support (Doty’s technique, n = 4; Brom’s technique, n = 1; McGoon’s technique, n = 1), and eight reoperations (Doty’s technique, n = 5; Brom’s technique, n = 2; McGoon’s technique, n = 1) occurred. In cases of reoperation, adjustment of the shape and position of the right coronary sinus patch relieved the malignant arrhythmia. Conclusion Different surgical techniques have different effects on the right coronary artery. The shape of the patch inserted into the right coronary sinus should be carefully clipped to avoid distortion and ischemia of the right coronary artery.

scholarly journals Diffuse Supravalvular Aortic Stenosis: Surgical Repair in Adulthood

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Giovanni Ferlan ◽  
Claudio De Pasquale ◽  
Concetta Losito ◽  
Annalisa Fiorella ◽  
Nicola Marraudino ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Three Dimensional ◽  
Ascending Aorta ◽  
Supravalvular Aortic Stenosis ◽  
Mechanical Prosthesis ◽  
Computed Tomographic ◽  
Valve Function ◽  
Normal Shape

We present the case of a 54-year-old woman in which a diffuse congenital supravalvular aortic stenosis (SVAS) was associated with a severe aortic valve incompetence and heavy calcification of the aortic annulus. Repair consisted in resection of the ascending aorta, patch augmentation of the hypoplastic aortic root and annulus, placement of a 20 mm Dacron tubular graft (Vascutek, Renfrewshire, UK) and aortic valve replacement with a mechanical prosthesis (Sorin, Turin, Italy). Follow-up echocardiography demonstrated normal prosthetic valve function and a postoperative three-dimensional computed tomographic scan showed a normal shape of the reconstructed ascending aorta.

Congenital Aortic Stenosis:

PEDIATRICS ◽  
1959 ◽  
Vol 23 (2) ◽  
pp. 347-347
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Surgical Techniques ◽  
Clinical Results ◽  
Anterior Chest Wall ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Congenital Aortic Stenosis ◽  
Direct Puncture ◽  
Aortic Obstruction

A group of 30 patients with congenital aortic stenosis, ranging in age from 4 to 39 years, has been extensively studied at the National Heart Institute. The majority of these patients revealed cardiomegaly and electrocardiographic evidence of left ventricular hypertrophy, and experienced symptoms which included dyspnea, angina and syncope. The severity and site of aortic obstruction (valvular or subvalvular) was evaluated by left heart catheterization. Measurements of left ventricular pressures were made either by the transbronchial route or by direct puncture of this chamber through the anterior chest wall. The aortic valve gradients, i.e., the differences between simultaneous peak systolic pressures in the left ventricle and aorta or peripheral artery, ranged from 15 to 172 mm Hg. It is currently the policy to recommend operation to patients with aortic stenosis who, regardless of symptoms, have aortic valve gradients in excess of 50 mm Hg. Present surgical techniques employing direct vision by means of hypothermia or extracorporeal circulation are discussed. Of the 18 patients operated upon, there are 15 survivors most of whom have had gratifying clinical results substantiated by post-operative hemodynamic studies.

scholarly journals IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001443
Author(s):  
Richard Paul Steeds ◽  
David Messika-Zeitoun ◽  
Jeetendra Thambyrajah ◽  
Antonio Serra ◽  
Eberhard Schulz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Surgical Aortic Valve Replacement ◽  
Ventricular Ejection Fraction ◽  
Patient Profile ◽  
Transcatheter Aortic Valve ◽  
The Impact

AimsThere is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsData from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age.ResultsOverall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001).ConclusionsThe present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

scholarly journals First-phase ejection fraction by cardiovascular magnetic resonance predicts outcomes in aortic stenosis

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Haotian Gu ◽  
Rong Bing ◽  
Calvin Chin ◽  
Lingyun Fang ◽  
Audrey C. White ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Proportional Hazards ◽  
Function Analysis ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Cox Proportional Hazards

Abstract Background First-phase ejection fraction (EF1; the ejection fraction measured during active systole up to the time of maximal aortic flow) measured by transthoracic echocardiography (TTE) is a powerful predictor of outcomes in patients with aortic stenosis. We aimed to assess whether cardiovascular magnetic resonance (CMR) might provide more precise measurements of EF1 than TTE and to examine the correlation of CMR EF1 with measures of fibrosis. Methods In 141 patients with at least mild aortic stenosis, we measured CMR EF1 from a short-axis 3D stack and compared its variability with TTE EF1, and its associations with myocardial fibrosis and clinical outcome (aortic valve replacement (AVR) or death). Results Intra- and inter-observer variation of CMR EF1 (standard deviations of differences within and between observers of 2.3% and 2.5% units respectively) was approximately 50% that of TTE EF1. CMR EF1 was strongly predictive of AVR or death. On multivariable Cox proportional hazards analysis, the hazard ratio for CMR EF1 was 0.93 (95% confidence interval 0.89–0.97, p = 0.001) per % change in EF1 and, apart from aortic valve gradient, CMR EF1 was the only imaging or biochemical measure independently predictive of outcome. Indexed extracellular volume was associated with AVR or death, but not after adjusting for EF1. Conclusions EF1 is a simple robust marker of early left ventricular impairment that can be precisely measured by CMR and predicts outcome in aortic stenosis. Its measurement by CMR is more reproducible than that by TTE and may facilitate left ventricular structure–function analysis.

Regression of left ventricular mass one year after aortic valve replacement for pure severe aortic stenosis

2002 ◽  
Vol 89 (4) ◽  
pp. 408-413 ◽  
Author(s):  
Harald P Kühl ◽  
Andreas Franke ◽  
David Puschmann ◽  
Friedrich A Schöndube ◽  
Rainer Hoffmann ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Left Ventricular Mass ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Ventricular Mass ◽  
One Year
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