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

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.

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

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Sef ◽  
S Brown ◽  
E Haslam ◽  
C Rajakaruna ◽  
C McAloon
Keyword(s):  
Aortic Valve ◽  
Pulmonary Oedema ◽  
Aortic Regurgitation ◽  
Aortic Root ◽  
Median Sternotomy ◽  
Preoperative Imaging ◽  
Acute Pulmonary Oedema ◽  
Severe Aortic Regurgitation ◽  
Bentall Procedure ◽  
Intimal Tear

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.

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

Cureus ◽  
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

Severe aortic regurgitation from systemic hypertension (without aortic dissection) requiring aortic valve replacement

1982 ◽  
Vol 49 (2) ◽  
pp. 473-477 ◽  
Author(s):  
Bruce F. Waller ◽  
Jerel M. Zoltick ◽  
Jeffrey H. Rosen ◽  
Nevin M. Katz ◽  
Mario N. Gomes ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Systemic Hypertension ◽  
Severe Aortic Regurgitation

scholarly journals Repair of Bicuspid Aortic Valve in the Presence of Endocarditis and Leaflet Perforation

2014 ◽  
Vol 41 (1) ◽  
pp. 67-69
Author(s):  
William D.T. Kent ◽  
Hadi D. Toeg ◽  
Jehangir J. Appoo
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Bicuspid Aortic Valve ◽  
Recurrent Infection ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Simplified Approach ◽  
Severe Aortic Regurgitation ◽  
History Of ◽  
Leaflet Coaptation

Aortic valve repair can be a good option in younger patients who have severe aortic regurgitation. A systematic, disease-directed approach can simplify repair. This case report describes how a simplified approach can be successfully applied to complex pathologic conditions of the aortic valve. A 49-year-old man with a bicuspid aortic valve and a history of endocarditis presented with severe aortic regurgitation and evidence of recurrent infection. Intraoperatively, we found congenital and degenerative aortic anatomy with endocarditis and perforation. We performed aortic valve repair to enable leaflet coaptation and to adjust the coaptation height. After 24 months, the patient remained well, with an intact repair and trivial aortic regurgitation. We describe our systematic repair approach and rationales for targeting repairs to identified lesions. To our knowledge, this is the first description of complex aortic valve repairs in a patient who had simultaneous congenital, degenerative, and infectious conditions.

P6501Recurrent genetic aberrations in bicuspid aortic valve disease patients with isolated severe aortic regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Wang ◽  
B Wu ◽  
J Li ◽  
C Wang ◽  
X Shu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Bicuspid Aortic Valve ◽  
Genetic Variants ◽  
Early Onset ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Genetic Defects ◽  
Severe Aortic Regurgitation ◽  
Rare Genetic Variants

Abstract Background The etiology of bicuspid aortic valve disease (BAVD) is still unclear. Recent studies have demonstrated elevated prevalence of genetic defects in BAV patients with root phenotype, which includes aortic regurgitation and root-predominant dilatation. Purpose The present study intended to illustrate the feature of genetic defects among early-onset BAV patients with isolated severe aortic regurgitation. Methods From June 2015 to December 2017, whole exome sequencing was performed upon 27 BAVD patients with isolated severe aortic regurgitation under 45 years in our institution. Patients were categorized into right-left (R-L, n=16) and non-RL (n=11) cusp fusion types, and those with complex cardiac defects were excluded from the present study. Results Among 27 patients with a median age of 30.5 (18–44) years, only one was female with a rare left-non-coronary cusp fusion type. The prevalence of root phenotype was markedly higher in RL patients (56.3% vs 9.1%, p=0.018). In RL patients, the numbers of rare genetic variants (RGVs) were 15 in extracellular matrix genes, 8 in TGF-β signaling pathway genes, 2 in smooth muscle cell contraction apparatus genes, and 3 in familiar BAV related genes. In non-RL patients, the number of RGVs were 15, 3, 4, and 5, respectively. On the other hand, the number of RGVs in above gene clusters were 9, 6, 3, 2 in patients with a root phenotype, and 21, 5, 3, 6 in those without. Eight recurrent genetic variants were identified in 6 genes (see Table). An interesting observation was that ADAMTS2 variants were exclusively found among non-RL patients without root phenotype, as FBN2 variants among RL patients with root phenoype. Recurrent Rare Genetic Variants Gene Reference sequence Variant 1000G 1000G-East Asia Patients TGFBR2 NM_001024847.2 p.Val216Ile/c.646G>A 0.004 0.018 A16, A23 TGFBR2 NM_001024847.2 p.Thr340Met/c.1019C>T 0.003 0.015 A03, A05, A07 ADAMTS2 NM_014244.4 p.Gly1169Val/c.3506G>T 0.0044 0.021 A03, A15 FBN2 NM_001999.3 p.Gly475Val/c.1424G>T 0.0004 0.002 A19, A24 ELN NM_001278939.1 p.Pro93Leu/c.278C>T 0.0014 0.0069 A22, A26 COL4A5 NM_033380.2 p.Gly953Val/c.2858G>T 0.0079 0.03 A11, A17 MYLK NM_053025.3 p.Ser243Trp/c.728C>G 0.0002 0.001 A01, A02 MYLK NM_053025.3 p.Asp717Tyr/c.2149G>T 0.0024 0.011 A04, A21 Conclusion Recurrent genetic variants could be identified in a cohort of early-onset BAVD patients with isolated severe aortic regurgitation and staggering male predominance. The incidence and clinical relevance of these variants should be validated in an extended real-world BAV cohort.

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

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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