Surgical treatment of aortic root aneurysm: comparison of Bentall procedure and David reimplantation of aortic valve

Abstract Introduction Marfan syndrome (MFS) is a common heritable connective tissue disease involving multiple organs. Even though the clinical manifestations of MFS can be various, aortic root aneurysm is estimated as one of the most serious complications. We herein describe an individualized treatment decision-making process for a 23-year-old male with MFS, suffering from a giant but stable aortic root aneurysm which is extremely rare at his age. Case The patient, a 23-year-old male with a family history of MFS, presented to our cardiovascular department because of progressive exertional chest distress, fatigue and occasional precordial pain. Physical examinations revealed 190.5 cm of height, high myopia, and a diastolic murmur at the aortic valve area. Laboratory examinations for systemic vasculitis and infectious diseases were negative. Transthoracic echocardiography and enhanced thoracic computed tomography (CT) scan revealed the existence of a giant aortic root aneurysm (125.1 mm in short-axis), severe aortic valve regurgitation, cardiac dilatation (LV; 99 mm in diastolic diameter) and a poor ejection fraction (EF; 18%). Considering the risk of rupture or dissection of the dilated aortic root, we performed Bentall procedure based on the results of multidisciplinary team discussion and intraoperative exploration. Postoperative thoracic CT scan revealed a normal sized reconstructed aortic root, and the patient was discharged uneventfully 7 days later. Conclusion It is extremely rare to report such a giant aortic root aneurysm in a young patient. In the treatment decision-making process, the patient’s specific situation should be taken into consideration. A mechanical Bentall procedure seems to be an acceptable option for some selected cases.

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Management of a giant aortic root aneurysm in a young patient with Marfan syndrome: a case report

10.21203/rs.3.rs-44721/v2 ◽

2020 ◽

Author(s):

JIAYU SHEN ◽

Changping Gan ◽

R.D.T. Rajaguru ◽

Dou Yuan ◽

ZHENGHUA XIAO

Keyword(s):

Decision Making ◽

Aortic Valve ◽

Ct Scan ◽

Young Patient ◽

Aortic Root ◽

Treatment Decision ◽

Decision Making Process ◽

Aortic Root Aneurysm ◽

Treatment Decision Making ◽

Bentall Procedure

Abstract IntroductionMarfan syndrome (MFS) is a common heritable connective tissue disease involving multiple organs. Even though the clinical manifestations of MFS can be various, aortic root aneurysm is estimated as one of the most serious complications. We herein describe an individualized treatment decision-making process for a 23-year-old male with MFS, suffering from a giant but stable aortic root aneurysm which is extremely rare at his age.CaseThe patient, a 23-year-old male with a family history of MFS, presented to our cardiovascular department because of progressive exertional chest distress, fatigue and occasional precordial pain. Physical examinations revealed 190.5cm of height, high myopia, and a diastolic murmur at the aortic valve area. Laboratory examinations for systemic vasculitis and infectious diseases were negative. Transthoracic echocardiography and enhanced thoracic computed tomography (CT) scan revealed the existence of a giant aortic root aneurysm (125.1 mm in short-axis), severe aortic valve regurgitation, cardiac dilatation (LV; 99 mm in diastolic diameter) and a poor ejection fraction (EF; 18%). Considering the risk of rupture or dissection of the dilated aortic root, we performed Bentall procedure based on the results of multidisciplinary team discussion and intraoperative exploration. Postoperative thoracic CT scan revealed a normal sized reconstructed aortic root, and the patient was discharged uneventfully 7 days later.ConclusionIt is extremely rare to report such a giant aortic root aneurysm in a young patient. In the treatment decision-making process, the patient’s specific situation should be taken into consideration. A mechanical Bentall procedure seems to be an acceptable option for some selected cases.

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Faculty Opinions recommendation of Assessment of long-term outcomes: aortic valve reimplantation versus aortic valve and root replacement with biological valved conduit in aortic root aneurysm with tricuspid valve.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739102463.793580885 ◽

2020 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Valve ◽

Tricuspid Valve ◽

Aortic Root ◽

Long Term Outcomes ◽

Aortic Root Aneurysm ◽

Valved Conduit ◽

Aortic Valve Reimplantation

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Aortic Valve-Sparing Operations for Aortic Root Aneurysm

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/stcs.2001.22990 ◽

2001 ◽

Vol 13 (3) ◽

pp. 291-296 ◽

Cited By ~ 15

Author(s):

Tirone E. David

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Aortic Root Aneurysm ◽

Valve Sparing

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The deadly “bulging balloon” within the mediastinum: a case of a giant aortic root aneurysm in a young patient with Marfan syndrome

10.21203/rs.3.rs-44721/v1 ◽

2020 ◽

Author(s):

JIAYU SHEN ◽

Changping Gan ◽

R.D.T. Rajaguru ◽

Dou Yuan ◽

ZHENGHUA XIAO

Keyword(s):

Decision Making ◽

Aortic Valve ◽

Ct Scan ◽

Young Patient ◽

Marfan Syndrome ◽

Aortic Root ◽

Treatment Decision ◽

Decision Making Process ◽

Aortic Root Aneurysm ◽

Treatment Decision Making

Abstract Introduction: Marfan syndrome (MFS) is a common heritable connective tissue disease involving multiple organs. Even though the clinical manifestations of MFS can be various, aortic root aneurysm is estimated as one of the most serious complications. We herein describe an individualized treatment decision-making process for a 23-year-old male with MFS, suffering from a giant but stable aortic root aneurysm which is extremely rare at his age. Case: The patient, a 23-year-old male with a family history of MFS, presented to our cardiovascular department because of progressive exertional chest distress, fatigue and occasional precordial pain. Physical examinations revealed six-foot-three inches of height, high myopia, and a diastolic murmur at the aortic valve area. Laboratory examinations for systemic vasculitis and infectious diseases were negative. The transthoracic echocardiography (TTE) and enhanced thoracic computed tomography (CT) scan revealed the existence of a giant aortic root aneurysm (125.1 mm in short-axis), severe aortic valve regurgitation, cardiac dilatation (LV; 99 mm in diastolic diameter) and a poor ejection fraction (EF; 18%). Considering the risk of rupture or dissection of the dilated aortic root, we successfully performed the Bentall procedure based on the intraoperative exploration results. Postoperative thoracic CT scan revealed a normal sized reconstructed aortic root, and the patient was discharged uneventfully 7 days later. Conclusion It is extremely rare to report such a giant aortic root aneurysm in a young patient. In the treatment decision-making process, the patient’s specific situation should be taken into consideration. The composite replacement of the aortic valve and ascending aorta should be performed if the patient is not suitable for valve-sparing operation.

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