scholarly journals WRAPPING OF THE MODERATELY DILATED ASCENDING AORTA BY FRESH AUTOLOGOUS PERICARDIUM

2021 ◽  
Author(s):  
Antonio Calafiore ◽  
Sotirios Prapas ◽  
Kostas katsavrias ◽  
Michele Di Mauro ◽  
Panayiotis Zografos ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Vasa Vasorum ◽  
Severe Mitral Regurgitation ◽  
Coronary Surgery ◽  
Transthoracic Echocardiogram ◽  
Late Mortality ◽  
Autologous Pericardium

Background and aim of the study. Wrapping of the ascending aorta (AA), isolated or associated with aortoplasty, has never been completely accepted. Some complications, as folding of the aortic wall, compression of the vasa vasorum and changes in the flow pattern, with consequent dilatation of the proximal arch, have been described. We used fresh autologous pericardium (FAP), so far never reported, to wrap the AA, with the aim to stabilize its size when moderately dilated, maintaining the preoperative dimension or limiting the reduction to a few mm. Material and Methods. From 2015 to 2019, 10 patients, who were operated on for valve or coronary surgery or both, underwent wrapping of the AA with FAP. Mean age was 69±7 years and ESII 3.5±1.7. Four patients had moderately impaired ejection fraction (35-49%). Results. There was no early or late mortality. One patient was reoperated on after 48 months for severe mitral regurgitation. At a follow up of 53±14 months, a transthoracic echocardiogram showed that the AA size reduced slightly but significantly, from 45.2±2.0 to 42.5±4.1 mm, p=0.03. The diameter of the proximal arch remained unchanged, from 37.1±1.6 to 36.3±2.9 mm, p=0.20. Conclusions. In presence of moderately dilated AA wrapping can be a reasonable option. The use of FAP stabilizes the size of the aorta after a follow up of 53 months. Maintaining a size similar to the preoperative one avoids the complications related to the procedure.

Anterior Mediastinal Paraganglioma Mimicking Thymoma

2012 ◽  
Vol 15 (3) ◽  
pp. 170
Author(s):  
Hee Moon Lee ◽  
Dong Seop Jeong ◽  
Pyo Won Park ◽  
Wook Sung Kim ◽  
Kiick Sung ◽  
...  
Keyword(s):  
Mediastinal Mass ◽  
Aortic Wall ◽  
Anterior Wall ◽  
Ascending Aorta ◽  
Anterior Mediastinal Mass ◽  
Arterial Reconstruction ◽  
Ct Evaluation ◽  
One Year ◽  
Mediastinal Paraganglioma

A 54-year-old man was referred to our institution with hemoptysis and hoarseness of 1 year's duration. A computed tomography (CT) scan showed an anterior mediastinal mass (2.5 cm x 1.0 cm), which was diagnosed as thymoma. The tumor was resected under a sternotomy. The tumor had invaded the anterior wall of the ascending aorta. With the patient under cardiopulmonary bypass, the aortic wall invaded by the mass was resected, and arterial reconstruction was performed with patch material. The tumor was revealed to be a tumor of neuronal origin. The patient's postoperative course was uneventful. The patient was discharged on postoperative day 9. One year after the operation, a follow-up chest CT evaluation showed no specific complications or recurrence.

scholarly journals A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110377
Author(s):  
Yasuhito Nakamura ◽  
Kiyoshi Doi ◽  
Syojiro Yamaguchi ◽  
Etsuji Umeda ◽  
Osamu Sakai ◽  
...  
Keyword(s):  
Rare Case ◽  
Aortic Wall ◽  
Aortic Rupture ◽  
Ascending Aorta ◽  
Bleeding Site ◽  
Penetrating Aortic Ulcer ◽  
Postoperative Course ◽  
Life Threatening ◽  
Aortic Dissections

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

scholarly journals Recurrent mitral regurgitation after mitral valve repair for bileaflet lesions in the modern era

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Daisuke Kaneyuki ◽  
Hiroyuki Nakajima ◽  
Toshihisa Asakura ◽  
Akihiro Yoshitake ◽  
Chiho Tokunaga ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Late Phase ◽  
Severe Mitral Regurgitation ◽  
Valve Repair ◽  
Sequential Approach ◽  
Posterior Mitral Leaflet ◽  
Quadrangular Resection

Abstract Background Good mid-term durability of mitral valve repair of bileaflet lesions has been reported; however, patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions. Methods Fifty-six patients (mean age 67 ± 12 years) underwent mitral valve repair of bileaflet lesions due to degenerative disease in 2011–2018. Mitral annuloplasty was added to all procedures except for 1 patient with annular calcification. Mitral valve lesions were identified by surgical inspection. Mean clinical and echocardiography follow-up occurred at 2.7 ± 2.1 and 2.5 ± 1.9 years, respectively. Results Additional mitral valve repair techniques involved triangular resection (n = 15 patients), quadrangular resection with sliding plasty (n = 12), neochordoplasty (n = 52), and commissural plication (n = 26). Prolapse of ≥2 anterior and posterior leaflet scallops occurred in 22 (39%) and 30 (54%) patients, respectively. During follow-up, 10 (17.8%) patients developed moderate or severe mitral regurgitation. Whereas prolapse or tethering was observed early after neochordoplasty or quadrangular resection, recurrent regurgitation occurred late after commissural repair. Five-year freedom from recurrent moderate or severe mitral regurgitation rates was 71.1 ± 11.0%. Conclusions Seventeen percent of patients developed recurrent mitral regurgitation during follow-up. Repair failure in the early phase occurred owing to aggressive resection of the posterior mitral leaflet or maladjustment of the artificial neochordae. Recurrent mitral regurgitation might occur in the late phase even after acceptable commissural repair. A sequential approach may be useful to improve the quality of mitral valve repair in bileaflet lesions.

Mitral perforation: a rare cause of congenital mitral regurgitation

2003 ◽  
Vol 13 (5) ◽  
pp. 472-474 ◽  
Author(s):  
Funda Öztunç ◽  
Irfan Levent Saltık ◽  
Halil Türkoğlu
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Severe Mitral Regurgitation ◽  
Cross Sectional ◽  
Autologous Pericardium ◽  
Aortic Leaflet ◽  
Congenital Mitral Regurgitation

In a 4-year-old boy with severe mitral regurgitation, cross sectional echocardiography combined with Doppler interrogation confirmed the presence of isolated perforation of the aortic leaflet of the mitral valve. The perforation was closed with a patch of fresh autologous pericardium. Serial echocardiograms taken postoperatively showed no regurgitation across the mitral valve.

Reconstruction of the mitral valve in children— long-term follow-up in 63 cases

1994 ◽  
Vol 4 (3) ◽  
pp. 285-290 ◽  
Author(s):  
Fause Attie ◽  
Carlos Zabal ◽  
Alejandro Juárez ◽  
Alfonso Buendía-Hernández ◽  
Rodolfo Barragán ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mortality Rate ◽  
Mitral Regurgitation ◽  
Class Ii ◽  
Functional Class ◽  
Surgical Reconstruction ◽  
Class Iii ◽  
Late Mortality ◽  
Cardiothoracic Ratio

SummaryBetween June 1985 and June 1991, 63 children underwent surgical reconstruction of the mitral valve for rheumatic (46 cases), congenital (12 cases) and myxoid (five cases) disease. The ages ranged from two to 18 years (mean 14.1±3.7 years). Valvar dysfunction was classified according to its pathophysiological abnormalities. A group of four cases presented with regurgitation secondary to lesions located in the valvar structures but with normal motion of the leaflets. In a second group of 14 cases, mitral regurgitation was due to prolapsed leaflets because of lesions located mainly in the subvalvar structures. A third group was formed by 35 patients with mitral regurgitation with restricted motion of the leaflets due to lesions in the valvar and subvalvar structures. The final group, of 10 cases, presented with mitral stenosis. The overall surgical mortality rate was 4.7% (3/63), and follow-up data were available in all survivors from one to 96 months (mean 33.4±25.4). Four cases underwent reoperation due to residual incompetence, one case due to bacterial endocarditis, and two more are scheduled for replacement of the valve due to unfavorable evolution, giving an overall rate of reoperation of 4.3% per patient/year. One patient died in the period following valvar replacement (late mortality rate of 0.6% per patient/year). Thromboembolism occurred in four cases in the absence of anticoagulation; three of them were in atrial fibrillation (late thromboembolic rate 2.4% per patient/year). Prior to surgery, 28 cases were in functional class II of the New York Heart Association, 34 patients were in class III and one patient in class IV. At the end of the follow-up period, 49 patients were in class I, seven in class II and four in functional class III (p<0.0001). The cardiothoracic ratio before surgery ranged from 0.40 to 0.81 (mean 0.60±0.07) and, after surgery, the values ranged from 0.40 to 0.79 (mean 0.55±0.07) (p<0.0001). Randomized late echocardiographic evaluation in 24 cases revealed residual mild mitral regurgitation in 20 cases, moderate in two and severe in two. The latter are scheduled for valvar replacement. There were no significant differences in the surgical results among the four groups. Reconstruction of the mitral valve, therefore, provides stable functional results with low surgical and late mortality, as well as an acceptable rate of reoperation irrespective of the lesions of the valvar apparatus.

scholarly journals Surgical treatment of intramural hematoma of the ascending aorta

2016 ◽  
Vol 144 (3-4) ◽  
pp. 196-199
Author(s):  
Stamenko Susak ◽  
Aleksandar Redzek ◽  
Vladimir Torbica ◽  
Jovan Rajic ◽  
Mirko Todic
Keyword(s):  
Aortic Dissection ◽  
Open Surgery ◽  
Aortic Wall ◽  
Acute Aortic Dissection ◽  
Treatment Options ◽  
Intramural Hematoma ◽  
Ascending Aorta ◽  
Vasa Vasorum ◽  
Convex Side ◽  
Intimal Tear

Introduction. Intramural hematoma of the aorta presents potentially fatal condition developing as a result of a vasa vasorum rupture. It is a major risk factor for developing a frank aortic dissection. Case Outline. A 65-year-old woman was admitted to our clinic for the second time, after her symptoms of chest pain and vertigo (with no electrocardiographic signs of myocardial infarction) hadn?t disappeared after several months of medicament treatment (indicated in the first hospitalization). Computed tomography arteriography of the aorta showed no sign of acute aortic dissection, but revealed a contrast depo in the aortic wall of 8 ? 14 mm dimensions, with no extravasation of contrast. Also, massive pericardial effusion was observed (10-30 mm in thickness). Transesophageal echocardiography confirmed these findings completely. The patient underwent surgery, in which plaque exulceration was detected on the convex side of the ascending aorta, 3 cm above the aortic valve, 1 cm in diameter, with no signs of intimal tear. A resection of the ascending aorta was performed, and the aorta was reconstructed with a 30 mm Dacron tube graft. The patient was discharged on the 14th postoperative day with satisfactory results. Conclusion. Intramural hematoma is not a common event, but it is potentially a fatal one. Open surgery in patients with an intramural hematoma is an effective treatment strategy, although percutaneous endovascular treatment options are being described.

Long-Term Follow-Up of Minimally Invasive Cardiac Surgery Using an Endoaortic Occlusion System

2014 ◽  
Vol 17 (2) ◽  
pp. 93 ◽  
Author(s):  
Arndt-H. Kiessling ◽  
Philipp Kisker ◽  
Alexandra Miskovic ◽  
Nestoras Papadopoulos ◽  
Andreas Zierer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Structural Damage ◽  
Aortic Wall ◽  
Artery Bypass ◽  
Mitral Valve Surgery ◽  
Ascending Aorta ◽  
Invasive Technique

<p><b>Objectives:</b> We reviewed the initial patient series (n=116) of our institution performing minimally invasive coronary artery bypass grafting (CABG) (n=79), mitral valve surgery (n=1), or atrial septal closure (ASD) procedures (n=26) using an endoaortic occlusion system. With this technique relevant intra-aortic pressures are exerted on the aortic wall during the clamping time. This might lead to late aortic degeneration and aneurysm formation. Our study sought to evaluate postoperative aortic complications and the quality of life (modified SF-12).</p><p><b>Methods:</b> One hundred sixteen patients (56% male; 54 years � 14.5; range 19 years to 77 years) underwent a cardiac procedure using an endoaortic clamp. The endoaortic balloon clamp catheter was used to occlude the ascending aorta at pressures >300 mmHg. Patients were rescheduled for echocardiographic examination after a mean follow-up period of 8.8 years.</p><p><b>Results:</b> The analysis performed among 78 patients showed no incidence of any structural damage to the ascending aorta at the intraoperative position of the endoaortic balloon. The physical and mental summary scores are equal to those of comparable patient groups.</p><p><b>Conclusions:</b> The endoaortic occlusion system causes no damage to the aortic wall. If the system causes any problems, they occur immediately during surgery. Patients treated with this minimally invasive technique exhibited the same quality of life as those undergoing conventional surgery.</p>

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