scholarly journals Surgical Repair of Unruptured Pseudoaneurysm of Sinus of Valsalva in Aortic Stenosis

2021 ◽  
Vol 4 (12) ◽  
pp. 01-28
Author(s):  
Deepak Bohra
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Coronary Sinus ◽  
Surgical Repair ◽  
Diagnostic Tools ◽  
Sinus Of Valsalva ◽  
Mechanical Prosthesis ◽  
Prosthetic Patch

Isolated pseudoaneurysm of a sinus of Valsalva is an uncommon sequelae of infective endocarditis. It is very uncommon in native aortic valve stenosis as compared to aortic regurgitation. We present a case of a 46 year old gentleman with a severely stenotic aortic valve with infective endocarditis, and a pseudoaneurysm of the non coronary sinus of Valsalva. The pseudoaneurysm was repaired with a prosthetic patch and the aortic valve was replaced by a mechanical prosthesis. Transthoracic echocardiography and computed tomography aortogram are an ideal diagnostic tools in suspected cases. Surgery can be curative with excellent results.

scholarly journals How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice

2021 ◽  
Author(s):  
F. Contorni ◽  
M. Fineschi ◽  
A. Iadanza ◽  
A. Santoro ◽  
G. E. Mandoli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Left Ventricle Ejection Fraction ◽  
Low Flow ◽  
Diagnostic Tools ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation

AbstractLow-flow low-gradient aortic stenosis (LFLG AS) with reduced left ventricle ejection fraction (LVEF) is still a diagnostic and therapeutic challenge. The aim of this paper is to review the latest evidences about the assessment of the valvular disease, usually difficult because of the low-flow status, and the therapeutic options. Special emphasis is given to the available diagnostic tools for the characterization of LFLG AS without functional reserve at stress echocardiography and to the factors that clinicians should evaluate to choose between surgical aortic valve repair, transcatheter aortic valve implantation, or medical therapy.

scholarly journals “Sleeve” Sinus Valsalva Repair in Patients with Acute Type A Aortic Dissection

2020 ◽  
Author(s):  
Laichun Song ◽  
Yang Gao ◽  
Ming Xu ◽  
Bo Wang ◽  
Xiaoyong Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Aortic Dissection ◽  
Coronary Sinus ◽  
Computed Tomography Angiography ◽  
Aortic Root ◽  
Acute Type ◽  
Sinus Of Valsalva ◽  
Type A Aortic Dissection ◽  
Left And Right

Purpose. The optimal surgical strategy of aortic root in acute type A aortic dissection (ATAAD) is controversial. The aim of this study was to evaluate the feasibility and safety of “Sleeve” sinus Valsalva repair for AAD limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia. Methods: From Sep 2016 to Mar 2019, 20 patients with AAD involving non-coronary sinus or partial left and right coronary sinus Valsalva underwent “Sleeve” sinus Valsalva repair . Multi slice spiral computed tomography angiography (MSCT) and three dimensional reconstruction were routinely performed in all patients to assess the maximal diameters of each segment of the aorta. Results. There was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 1 patient and no bleeding was related to the proximal anastomosis. The post-operative drainage was 390.5±229.3mL. During the following-up, the echocardiography showed the normal sinus of Valsalva and aortic valvular function. The computed tomography angiography showed normal aortic root without endovascular leak or dissection around the sinus of Valsalva. All patients were free from reoperation. Conclusions. “Sleeve” sinus Valsalva repair with Dacron patch for aortic dissection limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia was technically feasible and safe.

scholarly journals Reclassification of aortic stenosis by fusion of echocardiography and computed tomography in low-gradient aortic stenosis

2020 ◽  
Author(s):  
N. El Faquir ◽  
M. E. Vollema ◽  
V. Delgado ◽  
B. Ren ◽  
E. Spitzer ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Clinical Outcome ◽  
Aortic Stenosis ◽  
Fusion Imaging ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Cardiac Mortality ◽  
Ventricular Ejection Fraction

Abstract Background The integration of computed tomography (CT)-derived left ventricular outflow tract area into the echocardiography-derived continuity equation results in the reclassification of a significant proportion of patients with severe aortic stenosis (AS) into moderate AS based on aortic valve area indexed to body surface area determined by fusion imaging (fusion AVAi). The aim of this study was to evaluate AS severity by a fusion imaging technique in patients with low-gradient AS and to compare the clinical impact of reclassified moderate AS versus severe AS. Methods We included 359 consecutive patients who underwent transcatheter aortic valve implantation for low-gradient, severe AS at two academic institutions and created a joint database. The primary endpoint was a composite of all-cause mortality and rehospitalisations for heart failure at 1 year. Results Overall, 35% of the population (n = 126) were reclassified to moderate AS [median fusion AVAi 0.70 (interquartile range, IQR 0.65–0.80) cm2/m2] and severe AS was retained as the classification in 65% [median fusion AVAi 0.49 (IQR 0.43–0.54) cm2/m2]. Lower body mass index, higher logistic EuroSCORE and larger aortic dimensions characterised patients reclassified to moderate AS. Overall, 57% of patients had a left ventricular ejection fraction (LVEF) <50%. Clinical outcome was similar in patients with reclassified moderate or severe AS. Among patients reclassified to moderate AS, non-cardiac mortality was higher in those with LVEF <50% than in those with LVEF ≥50% (log-rank p = 0.029). Conclusions The integration of CT and transthoracic echocardiography to obtain fusion AVAi led to the reclassification of one third of patients with low-gradient AS to moderate AS. Reclassification did not affect clinical outcome, although patients reclassified to moderate AS with a LVEF <50% had worse outcomes owing to excess non-cardiac mortality.

Surgical Repair of a Sinus of Valsalva Aneurysm: A 22-Year Single-Center Experience

2019 ◽  
Author(s):  
Jun Ho Lee ◽  
Ji-Hyuk Yang ◽  
Pyo Won Park ◽  
Jinyoung Song ◽  
June Huh ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Surgical Repair ◽  
Sinus Of Valsalva ◽  
Optimal Method ◽  
Term Survival ◽  
Dual Approach ◽  
Single Center Experience ◽  
Grade Ii

Background Several reports described the repair of sinus of Valsalva aneurysms (SVAs); however, there is still debate regarding the optimal method of operation. We investigated the determinants of the development of significant aortic regurgitation (AR) and long-term survival after surgical repair. Methods Between January 1995 and December 2016, 71 patients (31 females; median age: 33.3 years) underwent surgical SVA repair with (n = 60) or without (n = 11) rupture. Aortic valvuloplasty (AVP) was performed using Trusler's technique in 28 patients (39.4%), and 11 patients (15.5%) underwent aortic valve replacement during the first operation. Results There was no early mortality, and three deaths occurred during follow-up (median: 65.4 months). Patients with grade II preoperative AR who underwent AVP tended to develop significant postoperative AR, but freedom from significant AR did not differ statistically (p = 0.387). Among patients who underwent AVP, freedom from significant AR did not differ statistically between those with grades I and II and those with grades III and IV (p = 0.460). Conclusion Surgical repair of SVA with or without rupture can be performed safely using the dual approach technique. Concomitant aortic valve repair can be performed without difficulty and should be recommended not only for patients with moderate or severe preoperative AR (grades III and IV) but also for those with minimal or mild preoperative AR (grades I and II), whose aortic valve geometry needs correction.

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