scholarly journals Endovascular Reconstruction from Aortic Valve to Aortic Arch Using One-Piece Valved-Fenestrated Stent Graft with a Branch: A Proof-of-Concept Study

2019 ◽  
Vol 22 (5) ◽  
pp. E380-E384 ◽  
Author(s):  
Tao Li ◽  
Xianhao Bao ◽  
Jiaxuan Feng ◽  
Zhenjiang Li ◽  
Junjun Liu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Arch ◽  
Stent Graft ◽  
Coronary Arteries ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Sinus Of Valsalva ◽  
Fenestrated Stent Graft ◽  
Transapical Access

Objective: To explore the feasibility of endovascular reconstruction of aortic root including aortic valve, sinus of valsalva and ascending aorta by a single stent-graft, a novel valved stent-graft with two fenestrae for preserving the coronary arteries was designed and performed in-vitro on a pig heart based circulation simulating system. Methods: Pig hearts were harvested from 30 healthy adult female pigs weighing between 60-65 kilograms. Before sacrifice, all the pigs received aortic computed tomography angiography (CTA) examinations and morphologic parameters of aortic root were measured. Then we customized the valved stent-grafts according to the CTA measurements. After the pig heart was fixed on the special platform according to the original orientation and connected to the circulation system, the stent graft was delivered through transapical access and covered the segment from aortic annulus to proximal part of aortic arch under DSA (digital subtraction angiography) guidance. Then changes of coronary flow before and after the procedure and fenestration alignment with coronary ostia were analyzed. Results: The overall technical success rate was 100%. The valve functions tested by ultrasound were in good condition under 120 mmHg circulation pressure. The flow of left coronary artery (LCA) did not decrease, but increased after the stent-graft implantation (340 ± 2.06 mL/min versus 288 ± 5.29 mL/min, P < .05). Similarly, the flow of right coronary artery (RCA) also increased (392 ± 9.17 mL/min versus 348 ± 8.01 mL/min; P < .05). The final angiography confirmed that both coronary arteries were patent. When generally observed from outer wall of valsalva sinus, both RCA and LCA orifices were aligned with the fenestrae. In 4 cases, the autologous valve leaflets blocked nearly 20% of the LCA fenestra’s area, but the flow did not significantly decrease in these cases. Conclusion: Stimulated on a pig heart-based circulation simulation system, the one-piece valved-fenestrated stent graft with a branch could be delivered via the transapical access and deployed accurately, which achieved endovascular reconstruction of aortic valve, sinus of valsalva and ascending aorta while preserving the coronary artery perfusion by fenestrations. More in-vivo experiments on animal models are mandatory to further verify its efficacy and safety.

scholarly journals Successful case of Benthal de Bono surgery in Cabrol modification with one-step aortic arch prosthesis and repeat coronary artery bypass surgery in a patient with de Bakey type 1 acute aortic dissection

2021 ◽  
Vol 38 (3) ◽  
pp. 153-158
Author(s):  
B. K. Kadyraliev ◽  
V. B. Arutyunyan ◽  
S. V. Kucherenko ◽  
V. N. Pavlova ◽  
E. S. Spekhova ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Arch ◽  
Aortic Root ◽  
Artery Bypass ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Golden Standard ◽  
Valve Reconstruction

The ascending aortic aneurysm occurs in 45 % of cases from the total number of aortic aneurysms of various localization. The incidence rate of combination of the aortic disease with aneurysm per 100 000 of the population is 5.9. The problem of prosthetics of the aortic root and aortic valve due to aneurysm and the changed AV is rather actual. The main principle of aneurysm surgery is the prevention of the risk of dissection and rupture with reconstruction of normal dimensions of the ascending aorta. Currently, there are different techniques for the treatment of root aneurysms and ascending aorta. The standard techniques are aortic root replacement, aortic valve reconstruction with replacement of aortic root or ascending aorta and partial or full replacement of aortic arch depending on the situation. The Bentall De Bono operation at present remains a golden standard of surgical treatment of the aneurysms of the root and ascending aorta with changed aortic valve. This surgery can have the following complications: thrombotic, thromboembolic followed by conduit dysfunction, formation of false anastomosis aneurysms, hemorrhage, compression of coronary artery orifices due to tension in the zone of coronary anastomoses.

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

VASA ◽  
2005 ◽  
Vol 34 (3) ◽  
pp. 181-185 ◽  
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.

Unusual Intramural Coronary Artery With Vertical Course Complicating an Arterial Switch Operation

2017 ◽  
Vol 10 (2) ◽  
pp. 231-234
Author(s):  
Lok Sinha ◽  
Richard A. Jonas ◽  
Pranava Sinha
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Arterial Switch Operation ◽  
Ascending Aorta ◽  
Sinus Of Valsalva ◽  
Arterial Switch ◽  
Switch Operation ◽  
Technical Modifications ◽  
Intramural Coronary Artery

Intramural coronary arteries in patients with d-transposition of the great arteries (d-TGA) usually arise from the opposite sinus of Valsalva and traverse horizontally across the posterior/facing commissure before emerging externally from the appropriate sinus of Valsalva. Failure to make appropriate technical modifications during coronary transfer can result in an important risk of posttransfer ischemia. We report a case with an unusual course of an intramural left anterior descending (LAD) coronary artery in a patient with d-TGA, with origin at the mid ascending aorta and a vertical intramural course, increasing the susceptibility to injury during an arterial switch operation (ASO).

scholarly journals Anomalous origin of right coronary artery from left coronary sinus associated with aneurysm of aortic root

2018 ◽  
Vol 2 (Issue 4) ◽  
pp. 123 ◽  
Author(s):  
Rustem Tuleutayev ◽  
Daurenbek Urazbekov ◽  
Kuat Abzaliyev ◽  
Kyanysh Ongarbayev
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Left Main Coronary Artery ◽  
Anomalous Origin ◽  
Sinus Of Valsalva ◽  
Left Main ◽  
Common Area

Prevalence of anomalous origin of right coronary artery (RCA) from left coronary sinus in population according to autopsy studies is 0.026%. Origin of left main coronary artery and RCA from opposite sinus of Valsalva with further course of anomalous vessels between aorta and pulmonary artery often is linked to sudden death.  We present a case of anomalous origin of RCA from left coronary sinus and aneurysm of aortic root. Our case demonstrates that when both coronary arteries` ostia are close to each other coronary arteries can be re-implanted on common area.  Firstly, this prevents distention and deformation of coronary arteries that might cause myocardial infarction. Secondly, it reduces time of placing anastomosis thus decreasing period of myocardial ischemia and cardiopulmonary bypass time.

P1823Aortic walls elastic properties assessment with ultrafast ultrasound imaging in case of bicuspid aortic valve

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Goudot ◽  
T Mirault ◽  
C Cheng ◽  
M Gruest ◽  
J Amoah ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Ultrasound Imaging ◽  
Bicuspid Aortic Valve ◽  
Aortic Stiffness ◽  
Cardiac Cycle ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Aortic Dilatation ◽  
Sinus Of Valsalva

Abstract Background Magnetic resonance imaging allows evaluation of aortic stiffness by the maximum rate of systolic distension (MRSD) a new prognosis factor of aortic dilatation in patients with bicuspid aortic valve (BAV). MRSD requires a continuous monitoring of the aortic diameter during the cardiac cycle, not accessible to conventional echocardiography contrary to ultrafast ultrasound imaging (UF). Purpose To develop specific aortic sequences in ultrafast ultrasound imaging (UF) to provide access to the aortic MRSD Methods Tissue Doppler allowed a precise estimation of the movement of each wall and the fine variation of the aortic diameter. To automatically track the anterior and posterior aortic walls during the cardiac cycle, we developed in the laboratory a specific interface (Figure). MRSD was the maximum of the derivative of the diameter chande over time. To assess this new technique, 24 patients (10 BAV patients and 14 controls, mean age 45.8 vs. 40.7 years, p=0.464, respectively) were consecutively included at a reference center for BAV. The ascending aorta was evaluated at the sinus of Valsalva, the tubular aorta and the aortic arch with a phased array probe (Supersonic Imagine) and dedicated sequences at 2000 frames/s. Results The lab-made interface allowed to track the aortic diameter and to calculate the MRSD from the UF acquisitions for each patient. We found lower MRSD at the sinus of Valsalva in case of BAV in accordance with previously demonstrated higher stiffness at this segment by our team (Table). Table 1. UF Aortic parameters for BAV patients and controls BAV patients Controls p (Mann Whitney) Sinus of Valsalva Diameter (mm) 26.2 [22.4–32.5] 27.09 [23.5–29.5] 0.796 MRSD (s–1) 1.05 [0.73–1.19] 1.51 [1.28–1.99] 0.023 Tubular ascending aorta Diameter 31.4 [29.4–32.2] 28.9 [22.6–31.5] 0.328 MRSD 0.94 [0.59–1.27] 1.09 [0.87–1.41] 0.353 Aortic arch Diameter 24.2 [23.7–24.8] 24.2 [18.9–24.5] 0.673 MRSD 0.57 [0.35–1.07] 0.85 [0.76–1.02] 0.257 Results are median [25th–75th percentile]. Figure 1 Conclusion UF allows evaluation of aortic stiffness by MRSD using dedicated sequence and interface. As echocardiography, UF is easily accessible and therefore deserves attention from cardiologists taking care of BAV patients to evaluate the segmental aortic remodeling associated with BAV.

Ascending aorta replacement in patients with coronary ostia localized above the sinotubular junction

2020 ◽  
Author(s):  
Paul P Urbanski ◽  
Vadim Irimie ◽  
Anno Diegeler ◽  
Aleksandra Morka ◽  
Tarvo Thamm ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Ascending Aorta ◽  
Sinus Of Valsalva ◽  
Study Objective ◽  
Sinotubular Junction ◽  
Aorta Aneurysm ◽  
Normal Sinus ◽  
Aorta Replacement ◽  
Patch Plasty

Abstract OBJECTIVES The study objective was to describe the technique and outcomes of original coronary ostial slide plasty in patients with anomalous coronary artery origin (ACAO) localized in the aneurysmal ascending aorta (AA) being replaced because of its isolated pathology and otherwise non-pathological aortic root. METHODS A total of 23 patients (median age 52 years) with the ascending phenotype of proximal aorta aneurysm and ACAO of at least 1 coronary artery localized in the AA being replaced underwent ostial slide plasty to transpose the ACAO to the respective sinus of Valsalva and, consequently, to allow an AA replacement with placement of the proximal anastomosis at the level of the sinotubular junction (STJ). In 15 patients, the aortic valve was bicuspid, and all but 3 patients presented with a relevant valve defect. In addition to remodelling the STJs (all patients), valve-sparing repair or replacement was performed in 12 and 8 patients, respectively. RESULTS No patient died during the entire follow-up (median 72, range 3–183 months). One patient required replacement of a recurrently insufficient valve that was repaired primarily using cusp patch plasty, but there were no further cardiac reoperations nor any re-interventions on the proximal aorta, aortic valve and/or coronary artery ostia. Two patients received peripheral coronary stents (8 and 7 years after surgery, respectively) due to coronary heart disease. CONCLUSIONS Transposition of the ACAO from the replaced AA into the normal sinus of Valsalva using the ostial slide plasty offers a simple and safe surgical option enabling a recreation of a durable STJ at the level of the anastomosis between the root and the aortic graft.

scholarly journals Fate of the Aortic Arch Following Surgery on the Aortic Root and Ascending Aorta in Bicuspid Aortic Valve

2018 ◽  
Vol 106 (3) ◽  
pp. 771-776 ◽  
Author(s):  
Rajdeep Bilkhu ◽  
Pouya Youssefi ◽  
Gopal Soppa ◽  
Panagiotis Theodoropoulos ◽  
Simon Phillips ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Ascending Aorta

Passing a Mechanical Aortic Valve With a Short Tip Dilator to Facilitate Aortic Arch Endovascular Branched Repair

2021 ◽  
pp. 152660282110025
Author(s):  
Nikolaos Konstantinou ◽  
Sven Peterss ◽  
Jan Stana ◽  
Barbara Rantner ◽  
Ramin Banafsche ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Stent Graft ◽  
Mechanical Valve ◽  
Valve Prosthesis ◽  
Proper Position ◽  
Mechanical Aortic Valve ◽  
Aortic Replacement ◽  
Custom Made ◽  
Aortic Valve Prosthesis

Purpose To present a novel technique to successfully cross a mechanical aortic valve prosthesis. Technique A 55-year-old female patient with genetically verified Marfan syndrome presented with a 5-cm anastomotic aneurysm of the proximal aortic arch after previous ascending aortic replacement due to a type A aortic dissection in 2007. The patient also underwent mechanical aortic valve replacement in 1991. A 3-stage hybrid repair was planned. The first 2 steps included debranching of the supra-aortic vessels. In the third procedure, a custom-made double branched endovascular stent-graft with a short 35-mm introducer tip was implanted. The mechanical valve was passed with the tip of the dilator on the lateral site of the leaflet, without destructing the valve and with only mild symptoms of aortic insufficiency, as one leaflet continued to work. This allowed the implantation of the stent-graft directly distally of the coronary arteries. Postoperative computed tomography angiography showed no endoleaks and patent coronary and supra-aortic vessels. Conclusion Passing a mechanical aortic valve prosthesis at the proper position is feasible and allows adequate endovascular treatment in complex arch anatomy. However, caution should be taken during positioning of the endovascular graft as the tip may potentially damage the valve prosthesis.

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