scholarly journals Giant unruptured sinus of Valsalva aneurysm successfully managed with valve-sparing procedure – a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Miklós Pólos ◽  
Cristina-Maria Șulea ◽  
Kálmán Benke ◽  
Bence Ágg ◽  
Attila Kovács ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Clinical Manifestations ◽  
Aortic Insufficiency ◽  
Sinus Of Valsalva ◽  
Suitable Alternative ◽  
Complete Replacement ◽  
Sinus Of Valsalva Aneurysm ◽  
Severe Aortic Regurgitation ◽  
Valve Sparing

Abstract Background Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence of less than 1% of open heart surgery cases. Its evolution is most frequently silent, being found incidentally or discovered in the event of its acute rupture. Non-ruptured giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion into the heart chambers or compression of the coronary vessels and are frequently associated with aortic insufficiency of various degrees of severity. The gold standard treatment for SVAs consists of complete replacement of the aortic root and valve. However, in certain cases, valve-sparing procedures may prove to be a more suitable alternative. Case presentation A 68-year-old male patient presented with dyspnea as symptom caused by a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most of the right ventricle and was associated with severe aortic regurgitation. The surgical treatment of the condition involved valve-sparing root reconstruction procedure (remodeling technique), completed with external stabilization of the aortic valve annulus via running suture annuloplasty. Following the uneventful intervention, the patient did well and his status improved. The follow-up transthoracic echocardiography obtained 1 month after surgery showed a fully competent aortic valve with no regurgitation. Conclusions Despite complete aortic root and valve replacement being considered the safest approach to large SVAs complicated with aortic insufficiency, valve-sparing procedures should not be overlooked in case of a dilated aortic root with uncalcified aortic valve. Performing valve-sparing by applying a remodeling technique operation completed with annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to implanted valves.

FINITE ELEMENT SIMULATIONS OF THE PHYSIOLOGICAL AORTIC ROOT AND VALVE SPARING CORRECTIONS

2006 ◽  
Vol 06 (01) ◽  
pp. 91-99 ◽  
Author(s):  
MONICA SONCINI ◽  
EMILIANO VOTTA ◽  
SILVIA ZINICCHINO ◽  
VALERIA BURRONE ◽  
ROBERTO FUMERO ◽  
...  
Keyword(s):  
Finite Element ◽  
Aortic Valve ◽  
Mechanical Behavior ◽  
Surgical Procedures ◽  
Aortic Root ◽  
Stress Pattern ◽  
Sinus Of Valsalva ◽  
Synthetic Graft ◽  
Valve Sparing ◽  
D Model

A 3-D model of the aortic root was developed consisting of aortic valve, sinus of Valsalva and aortic duct. Through finite element modeling, the mechanical behavior of the valve was investigated simulating four different configurations: physiological (baseline), aneurysmatic and corrected with two different sparing techniques, named after David and Yacoub, respectively. These surgical procedures imply the replacement of the sinus of Valsalva with a synthetic graft, inside which the cusps are resuspended. The final goal of this study consisted in the assessment of the mechanical effects of sinuses aneurysm on the whole root, as well as the effectiveness of the two aforementioned techniques in restoring valve functionality and normal stress values on the root substructures. Based on the assumption of three-leaflet symmetry, only one third of the aortic root was modeled. Two cardiac cycles were simulated and the mechanical behavior of the aortic root was evaluated in terms of stress pattern, contact pressure and contact areas observed during leaflets coaptation and when contact between the leaflet and the graft occurs. Both the sparing techniques are able to restore coaptation of the aortic valve, but for the David procedure, contact between the leaflet and the graft wall was detected.

scholarly journals Aortic root reimplantation procedure: a new milestone in aortic valve-sparing operations

2016 ◽  
Vol 20 (2) ◽  
pp. 49
Author(s):  
A. M. Chernyavskiy ◽  
D. S. Khvan ◽  
S. A. Alsov ◽  
D. A. Sirota ◽  
M. M. Lyashenko
Keyword(s):  
Aortic Valve ◽  
Conflict Of Interest ◽  
Aortic Root ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Long Term Follow Up ◽  
Valve Sparing ◽  
Reimplantation Procedure

<p><strong>Aim:</strong> Emphasis in this study was placed on clinical and functional assessment of a modified "Florida Sleeve" procedure during surgical correction of ascending aorta aneurysms with concomitant aortic insufficiency.<br /><strong>Methods:</strong> 32 patients with an aneurysm of the ascending aorta and aortic insufficiency underwent a modified "Florida Sleeve" procedure. The average follow-up was 17 (0-60) months. The average age of patients was 57±13 (23-73) years 56±13 years.<br /><strong>Results:</strong> The expected 4-year cumulative survival rate was 84.3%. Overall freedom from aortic insufficiency in the late period was 88.9%. Median aortic regurgitation was 1+ (1; 2). Long-term follow-up revealed no valve-associated complications.<br /><strong>Conclusion:</strong> The aortic root reimplantation procedure enables optimal correction of the existing lesions of the aortic root without performing aortic valve replacement and demonstrates stable clinical and functional outcomes in the long-term period.</p><p><strong>Key words:</strong> aortic aneurysm; aortic valve; valve-sparing operations.</p><p><strong>Funding</strong></p><p>The study had no sponsorship.</p><p><strong>Conflict of interest</strong></p><p>The authors declare no conflict of interest.</p>

scholarly journals Early and Midterm Outcomes of Valve-Sparing Aortic Root Replacement—Reimplantation Technique

Aorta ◽  
2018 ◽  
Vol 06 (05) ◽  
pp. 113-117
Author(s):  
Marisa Cevasco ◽  
Siobhan McGurk ◽  
Maroun Yammine ◽  
Lokesh Sharma ◽  
Julius Ejiofor ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Artery Bypass ◽  
Connective Tissue Disorder ◽  
Observation Time ◽  
Aortic Root Replacement ◽  
Severe Aortic Regurgitation ◽  
Prosthetic Valves ◽  
Valve Sparing

Background Valve-sparing aortic root replacement (VSARR) is an increasingly popular alternative to traditional aortic root replacement for aortic root aneurysm disease with a normal aortic valve. We evaluated the early and midterm outcomes of VSARR—reimplantation technique (VSARR-RT) done at a single institution over a decade. Materials and Methods We performed a retrospective study of all patients who underwent VSARR-RT between January 2004 and July 2014. Results A total of 85 patients underwent VSARR-RT. Median time to latest echocardiographic follow-up was 4 years (range: 15–72 months). Total observation time was 491 patient years. Mean age was 44.6 ± 14.3 years, and 13 (15%) were women. Thirty-nine (46%) patients had a connective tissue disorder and 6 (7%) had a bicuspid aortic valve. Thirty-three (39%) patients underwent concomitant procedures, including coronary artery bypass grafting (n = 9, 11%), mitral valve repair (n = 8, 9%), and aortic hemi-arch replacement (n = 7, 8%). There were no operative deaths or in-house mortality and no postoperative strokes. Kaplan-Meier analysis demonstrated survival of 99% (95% confidence interval [CI]: 97–100%) at 2 years and 98% (95% CI: 97–100%) at 8 years. Freedom from reoperation was 95.8% (95% CI: 91.2–100%) at 8 years. Freedom from endocarditis was 100% at 8 years. At the last echocardiographic follow-up, 95% of patients were free of severe aortic regurgitation (AR) and 82% free of moderate AR. Of the four patients who had severe AR, three underwent reoperations and received prosthetic valves and one is being clinically monitored. Conclusion This study reports early and midterm outcomes after VSARR-RT at our institution, including those patients who underwent a VSARR-RT procedure combined with other procedures. Further follow-up remains necessary to determine long-term outcomes.

scholarly journals Surgical Management of a Giant Left Sinus of Valsalva Aneurysm with Coronary Artery Abnormality

2021 ◽  
Vol 24 (2) ◽  
pp. E296-E298
Author(s):  
Long Song ◽  
Chukwuemeka Daniel Iroegbu ◽  
Chengming Fan ◽  
Xinmin Zhou
Keyword(s):  
Coronary Artery ◽  
Sinus Of Valsalva ◽  
Coronary Insufficiency ◽  
Sinus Of Valsalva Aneurysm ◽  
Coronary Artery Abnormality ◽  
Severe Aortic Regurgitation ◽  
Repair Technique ◽  
Valve Sparing ◽  
Aortic Root Repair ◽  
Left Sinus Of Valsalva

Coronary insufficiency caused by unruptured left sinus of Valsalva aneurysm (SVA) is exceedingly rare in the literature. Herein, we present a successful surgically treated case of giant left SVA with severe aortic regurgitation and coronary insufficiency, thus introducing a tailored valve-sparing aortic root repair technique.

scholarly journals Role of Transesophageal Echocardiography in Rupture of Sinus of Valsalva Aneurysm with Associated Infective Endocarditis

2016 ◽  
Vol 4 (2) ◽  
pp. 59-63
Author(s):  
Preeti Sharma ◽  
Goverdhan Dutt Puri ◽  
Harkant Singh ◽  
Bhupesh Kumar ◽  
Ganesh K Munirathinam
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Right Ventricle ◽  
Transesophageal Echocardiography ◽  
Previous History ◽  
Pulmonary Artery Hypertension ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm ◽  
Severe Aortic Regurgitation

ABSTRACT Introduction Sinus of Valsalva aneurysm (SOVA) may have associated infective endocarditis in which case single aneurysm may drain into adjacent chamber of heart via multiple openings. We report a rare case of congenital SOVA with associated infective endocarditis where intraoperative transesophageal echocardiogram (TEE) helped in localizing two separate openings in the SOVA draining into right ventricle and an associated perforation in the larger rightward cusp of bicuspid aortic valve (BAV) causing severe aortic regurgitation. Case report A 28-year-old male presented with grade III to IV dyspnea with previous history of infective endocarditis. Preoperative transthoracic echocardiogram (TTE) showed calcified BAV with severe aortic valve regurgitation and stenosis, severe tricuspid regurgitation, and pulmonary artery hypertension along with ruptured SOVA arising from right coronary sinus and draining into the right ventricle. Intraoperative TEE confirmed the TTE findings and in addition showed the presence of two jets arising from the SOVA draining into right ventricle, a subaortic membrane, and a perforation in the aortic cusp opening into left ventricle. The ruptured SOVA was repaired using single patch technique and aortic valve was replaced. The completeness of the repair was checked using TEE to exclude failure of closure of additional opening if any and the patient was discharged from hospital after 7 days of uneventful postoperative course. Conclusion Sinus of Valsalva aneurysm may have multiple openings draining into adjacent chamber, particularly if associated with infective endocarditis. Intraoperative TEE plays a crucial role in identification of multiple opening, involvement of adjacent structure, and assessment of completeness of repair. How to cite this article Kumar B, Munirathinam GK, Sharma P, Puri GD, Singh H. Role of Transesophageal Echocardiography in Rupture of Sinus of Valsalva Aneurysm with Associated Infective Endocarditis. J Perioper Echocardiogr 2016;4(2):59-63.

scholarly journals Approaches to aortic valve preservation in patients with aortic root an-eurysms and aortic insufficiency: the David procedure

2009 ◽  
Vol 15 (2) ◽  
pp. 142-145
Author(s):  
V. Uspenskiy ◽  
I. V. Sukhova ◽  
M. L. Gordeev
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Aortic Insufficiency ◽  
Aortic Valve Insufficiency ◽  
Short Term ◽  
Aortic Root Aneurysm ◽  
Valve Insufficiency ◽  
The Common ◽  
Valve Sparing ◽  
Aortic Valve Reimplantation

Background. Aortic valve-sparing operations are one of the relatively new approaches for treatment of patients with aortic root aneurysm and aortic valve insufficiency, but nowadays the common treatment strategy is absent. Methods. We studied the short-term results of David I valve-sparing operations in 19 patients with aortic root aneurysms and aortic insufficiency. Results. There were no lethal cases observed. 3 patients had mild aortic regurgitation, the majority of patients had no or trace aortic insufficiency. The significant decrease of left ventricle sizes was shown. Conclusions. The David I technique of aortic valve reimplantation seems to be optimal in patients with aortic root aneurysm, aortic insufficiency and normal aortic cusps.

Abstract 4281: Does Preoperative Aortic Insufficiency Affect Outcome Following Aortic Valve Sparing Surgery?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Laurent de Kerchove ◽  
Munir Boodhwani ◽  
David Glineur ◽  
Philippe Noirhomme ◽  
Gebrine El Khoury
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Systematic Approach ◽  
Cox Regression ◽  
Aortic Insufficiency ◽  
Rank Test ◽  
Term Outcome ◽  
Kaplan Meier ◽  
Valve Sparing

Aortic valve (AV) sparing surgery is an attractive option for the treatment of aortic root pathology. However, presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been associated with poorer outcome. We analyze the influence of preoperative AI severity and the need for cusp repair on the early and mid-term outcomes of AV sparing surgery. From 1996 to 2007, 134 consecutive patients underwent elective AV sparing surgery. (mean age − 52±16 years; 84% male). Significant preoperative AI (3+ or 4+) was present in 83 patients (62%) and 46 (34%) had a bicuspid valve. Root repair was performed with either the reimplantation (67%) or remodeling technique (33%). A systematic approach was used for intraoperative valve assessment and cusp repair was performed in 74 patients (55%). Clinical and echocardiographic follow-up was complete in 100% and 96% respectively at a mean follow-up time of 57 months (range: 12–147 months). Kaplan-Meier curves, log rank test, and Cox regression analyses were used. Hospital mortality was 0.7%. AV cusp repair was required in 53% of patients without significant AI and in 57% with significant AI (p=0.9). Cusp repair was required more frequently in bicuspid versus tricuspid valves (89% vs. 38%, p = 0.005). Overall survival at 5 and 8 years was 94±5% and 86±10% respectively. Freedom from recurrent AI (>2+) was similar with or without significant preoperative AI (90±10% vs. 86±10% at 5 years, p=0.5) and with or without cusp repair (87±11% vs. 89±10%, p=0.6; Figure 1). Freedom from AV reoperation at 5 years was similar with or without significant preoperative AI (94±6% vs. 89±8%, p=0.5) and with and without cusp repair (90±9% vs. 91±8%, p=0.8). With a systematic approach to valve assessment and cusp repair, AV sparing surgery for aortic root pathology has an acceptable early and mid-term outcome, irrespective of preoperative AI or need for cusp repair. Cusp repair is not predicted by presence of preoperative AI but is more frequent in bicuspid valves. Preoperative AI should not be considered a contra-indication for valve sparing surgery.

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