Aortic annulus elevation for aortic valve and root replacement

Aortic valve and root replacements require an in-depth understanding of the aortic root and annulus. Both structures can be asymmetric at times, and this needs to be recognized and taken into consideration when peforming valve-sparing operations or other root-replacement procedures. Moreover, the geometry of the aortic annulus can be altered, and when performing an aortic root replacement this can distort the geometry of a neo-aortic valve for instance, and lead to valve dysfunction, which is difficult to reverse. We are describing an altered aortic annulus, which required modification through annulus elevation before proceeding with aortic root replacement with a graft-reinforced pulmonary-autograft.

Characterization of Turbulent Flow Behind a Transcatheter Aortic Valve in Different Implantation Positions

The development of turbulence after transcatheter aortic valve (TAV) implantation may have detrimental effects on the long-term performance and durability of the valves. The characterization of turbulent flow generated after TAV implantation can provide fundamental insights to enhance implantation techniques. A self-expandable TAV was tested in a pulse replicator and the three-dimensional flow field was extracted by means of tomographic particle image velocimetry. The valve was fixed inside a silicone phantom mimicking the aortic root and the flow field was studied for two different supra-annular axial positions at peak systole. Fluctuating velocities and turbulent kinetic energy were compared between the two implantations. Velocity spectra were derived at different spatial positions in the turbulent wakes to characterize the turbulent flow. The valve presented similar overall flow topology but approximately 8% higher turbulent intensity in the lower implantation. In this configuration, axial views of the valve revealed smaller opening area and more corrugated leaflets during systole, as well as more accentuated pinwheeling during diastole. The difference arose from a lower degree of expansion of the TAV's stent inside the aortic lumen. These results suggest that the degree of expansion of the TAV in-situ is related to the onset of turbulence and that a smaller and less regular opening area might introduce flow instabilities that could be detrimental for the long-term performance of the valve. The present study highlights how implantation mismatches may affect the structure and intensity of the turbulent flow in the aortic root.

Retrieving a lost needle in the descending aorta during hemi-arch replacement

A 73-year-old man diagnosed with moderate aortic insufficiency and dilatation of the aortic root and ascending aorta underwent a modified Bentall procedure and hemi-arch aortic replacement. During open distal anastomosis of the ascending aorta, the surgical needle was lost. Because of circulatory arrest, the operation was continued; before closing the chest, radiography and a transesophageal echo were located in the needle in the descending aorta. It was retrieved using a snare catheter via the graft branch under fluoroscopic guidance. Thus, locating the needle in the descending aorta and leaving the graft branch uncut led to its removal without a new incision.

Aortic Root Dissection In A Patient With Previous Aortic Valve Replacement Due To External Automated Chest Compression Device For Cardiac Arrest

Myocardial damage from external cardiac massage can occur with either manual massage or with an automatic external device. We report the case of a patient with an aortic valve bioprosthesis undergoing advanced resuscitation with an automated external device for out-of-hospital-cardiac arrest, in whom the prolonged compressions caused an aortic root dissection.