BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic ...BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic valve complications.Longterm VSARR durability,especially in BAV patients,is debated.We hypothesize that VSARR outcomes differ between BAV and TAV patients in short-term and long-term settings.AIM To investigate short-term and long-term outcomes of VSARR in BAV vs TAV patients.METHODS This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis included observational studies comparing VSARR in adult BAV vs TAV patients.PubMed,ScienceDirect,and EMBASE were searched from inception to June 2025.Outcomes included mortality,reintervention,and procedural times.Pooled relative risk(RR)and mean differences(MD)with 95%CI were calculated.Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions;evidence certainty via GRADE.RESULTS Thirteen observational studies involving 1419 BAV and 2349 TAV patients were included.In-hospital mortality(RR=0.34,95%CI:0.10-1.14,P=0.08)and reoperation(RR=1.04,95%CI:0.64-1.69,P=0.87)showed no significant differences.All-cause mortality risk was significantly lower in BAV patients(RR=0.34,95%CI:0.13-0.86,P=0.02).Overall reintervention risk was significantly greater in BAV patients(RR=2.64,95%CI:1.96-3.55,P<0.00001).Aortic cross-clamp(MD=3.35 minutes,95%CI:-5.06 to 11.76,P=0.43)and cardiopulmonary bypass times(MD=3.96 minutes,95%CI:-10.26 to 18.18,P=0.59)showed no significant differences but substantial heterogeneity.The certainty of evidence was moderate for reintervention,low for mortality risk and in-hospital reoperation,and very low for procedural times.CONCLUSION VSARR demonstrates comparable short-term safety between BAV and TAV patients.However,BAV patients face a significantly higher long-term reintervention risk,highlighting the need for tailored strategies and further research.展开更多
Objective: To measure the calibration of different levels in aortic root andevaluate the relationships between the aortic sinuses and its neighbouring structure. Methods:Thirty heart specimens from cadaver of normal a...Objective: To measure the calibration of different levels in aortic root andevaluate the relationships between the aortic sinuses and its neighbouring structure. Methods:Thirty heart specimens from cadaver of normal adult were studied. The dimensions of four levels inaortic root were measured and the relationships between the aortic sinues and its neighbouringstructure were observed. Results: The dimensions of four levels in aortic root obtained as follows;Sinus > STJ1 > STJ0 > Base (P < 0.05) . The dimensions of the aortic valve leaflets were measured.The right coronary leaflet was larger than those of the left coronary and noncor-onary leaflets .But there was no statistical signiftcane (P > 0.05) . The relationships between the middle axis ofthe anterior valve of the bicuspid valve and the aortic sinuses were examined. The middle axis ofthe anterior valve in 26 specimens (86.6%) located between the left coronary sinus and thenoncoronary sinus . The relationship between the aortic prominence of the right atrium and theaortic sinuses was examined. The aortic prominence was formed from noncoronary sinus in 22 specimens(73.3%) . The relationship between the middle point of the right and left pulmonary valves and theaortic sinuses was examined. The middle point of the right and left pulmonary valves in 24 specimens(80%) was faced to the point between the right and left aortic sinuses . Conclusion: The dimensionof the four levels in aortic root is as follows, sinus > STJ1 > STJ0 > Base (P < 0.05) . There wasno statistical significance in the size of the three aortic valve leaflets (P > 0.05).展开更多
In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sin...In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sinus with just one trimmed Dacron graft. Between February 2001 and May 2010, we performed partial aortic root remodeling in 40 patients, who underwent emergency surgical intervention. The dissected sinuses were excised leaving a 3-5 mm rim of the aortic wall from the attached aortic valve cusps. A short piece （4-5 cm） of collagen coated woven polyester vascular prosthesis was trimmed with one or two ＂tongues＂ to reconstruct the non-coronary sinus and/ or the right coronary sinus, but without using separated patches. Additional procedures were including hemi-arch replacement in 11 patients, and total arch replacement plus stent-elephant trunk in 20 patients. The mean follow-up time was 36.4~3.6 months. In-hospital mortality was only 5.0% （2/40）; furthermore, 3 （8.6%） patients underwent re-operation of the aortic valve and 2 （5.7%） patients died during follow-up. At the end of follow-up, trivial or no aortic regurgitation was found in 33 patients, but mild aortic regurgitation was found in 2 patients. Our data suggest that the early and mid-term results of partial aortic root remodeling were favorable, and it restored valve durability and function. Thus, the use of technique for root reconstruction in patients with acute type A dissection should be vigorously encouraged.展开更多
Objective:Uric acid(UA) is considered to be a powerful predictor of cardiovascular risk and hyperuricemia might be involved in the metabolic syndrome(MS).This study aims to investigate the relation between UA levels a...Objective:Uric acid(UA) is considered to be a powerful predictor of cardiovascular risk and hyperuricemia might be involved in the metabolic syndrome(MS).This study aims to investigate the relation between UA levels and aortic root dilatation.Methods:A total of 348 hypertensive patients [age(67.5±9.8) years] with or without MS were included in the study.The aortic root diameters at the aortic annulus,the sinuses of Valsalva,the sinotubular junction,and the proximal part of the ascending aorta were measured using a two-dimensional(2D) echocardiography.Serum UA levels were also measured for all patients.Results:A high UA level is independently associated with aortic root diameters at the sinuses of Valsalva(P=0.001) and the proximal ascending aorta(P<0.0001) in the hypertensive patients without MS.In contrast,aortic root diameters were not significantly related to UA levels in the hypertensive patients with MS.Furthermore,increased UA levels were associated with an increased risk for aortic root dilatation in the patients without MS(sex-adjusted hazard ratio 1.75,95% confidence intervals(CI) 1.27-2.41),but not in those with MS.Conclusions:This study demonstrated an independent relationship between the aortic root dimensions and increased levels of serum UA in the hypertensive patients without MS.Further understanding of the mechanisms underlying these associations may allow a clearer interpretation of the potential value of specific urate-lowering treatment on cardiovascular disease.展开更多
The Loeys-Dietz syndrome (LDS) is a connective tissue disorder that is associated with vascular abnormalities, including aggressive aortic aneurysms, as well as skeletal and craniofacial malformations. The molecular m...The Loeys-Dietz syndrome (LDS) is a connective tissue disorder that is associated with vascular abnormalities, including aggressive aortic aneurysms, as well as skeletal and craniofacial malformations. The molecular mechanism of this syndrome remains to be fully elucidated. In this case, we describe a 29-year-old woman, gravida 2 para 1, who was referred for consultation after urinary tract malformations were observed during her mid-gestation anatomic survey. Following referral to our unit, ultrasound examination of the 21-week fetus was repeated. The fetus was observed to have a dilated aortic root and a poorly ossified sternum with mild pectus deformity. After elective termination, single nucleotide polymorphism microarray testing identified a novel 204 kb microdeletion involving the short arm of chromosome 3. The deleted genetic material included 4 exons of the TGFBR2 gene. Although the phenotype of LDS may be caused by haploinsufficiency of the TGFBR1 or TGFBR2 gene, our experience suggests a more complex picture of LDS. The study of such cases might further elucidate its pathogenesis.展开更多
The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imag...The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron<span style="white-space:nowrap;">®</span> tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.展开更多
Background:The study was aimed at investigating the mathematical relationship between the aortic valve and aortic root through CTA imaging-based reconstruction.Methods:We selected 121 healthy participants and analyzed...Background:The study was aimed at investigating the mathematical relationship between the aortic valve and aortic root through CTA imaging-based reconstruction.Methods:We selected 121 healthy participants and analyzed the measurements of aortic root dimensions,including the sinotubular junction(SJT),ventriculo-arterial junction(VAJ),maximum sinus diameter(SD),sinus height(SH),effective height(eH)and coaptation height(cH).We also reconstructed 3-D aortic valve cusps using CTA imaging to calculate the aortic cusp surface areas.Data were collected to analyze the ratios and the correlation between aortic valve and aortic root dimensions.Results:Among healthy participants,the STJ was approximately 10%larger than the VAJ,and the SD was 1.375 times larger than the VAJ.The average eH and cH were 8.94 mm and 3.62 mm,respectively.The aortic cusp surface areas were larger in men than women.Regardless of sex,the non-coronary cusp was found to be largest,and was fol-lowed by the right coronary cusp and the left coronary cusp.Although the aortic root dimensions were also significantly larger in in men than women,the STJ to VAJ,SD to VAJ,and SH to VAJ ratios did not significantly differ by sex.The mathematical relationship between the aortic cusp surface areas and VAJ orifice area was calculated as aortic cusp surface areas (mm^(2)) =1.512×{VAJ(mm)/2}^(2)×π+166.866. Conclusions:The aortic root has specific geometric ratios.The mathematical relationship between the aortic valve and aortic root might be used to guide aortic valve repair.展开更多
Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargem...Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period. Follow up in the outpatient department suggested all patients had NYHA class I symptoms and anticoagulation with warfarin adjusted to prothrombin time— International normalised ratio. Conclusion: Konno procedure is effective for managing small aortic root as bigger outflow orifice area through the larger valve prosthesis improves ventricular outflow and hence, improves the outcomes.展开更多
We describe a case of a 49-year-old man who presented with an uncomplicted aortic root aneurysm, aortic insufficiency, and ST-elevation myocardial infarction (STEMI) without obstructive coronary artery disease on angi...We describe a case of a 49-year-old man who presented with an uncomplicted aortic root aneurysm, aortic insufficiency, and ST-elevation myocardial infarction (STEMI) without obstructive coronary artery disease on angiography. The computed tomo- graphy angiogram (CTA) of the thorax, performed without cardiac gating, was misinterpreted as normal. In retrospect, an overlooked extravasation of contrast material lateral to the aortic root was detected on non-gating magnetic resonance angiography (MRA). Exploration of the aortic root revealed an unsuspected horizontal intimal tear of the left sinus of Valsalva with limited extramural hematoma. The presence of an otherwise silent intimal tear on preoperative imaging studies makes the overall management more problematic. For example, initiating early broad empirical anticoagulants or fibrinolytics therapy to treat the accompanied myocardial infarction may extend the tear into a full life-threatening aortic dissection, tamponade or rupture. We highlight many of the difficulties associated with the diagnosis and treatment of limited sinus tear when aortic root aneurysm is presenting with cryptogenic STEMI. Accurate morphologic characterization of intimal tear would be best defined with either an electrocardiogram-gating CTA or MRA imagings. These non-invasive tests are needed to make appropriate management decisions. Depending on other pathologic components of aortic root, cusps and the commissural geometry, sinus tear is a critical component for the overall treatment plan and it shifts the surgical intervenetion from valve-sparing operation, commissural resuspension and leaflet repair to composite aortic root replacement (modified version of the Bentall procedure).展开更多
Background: Acute myocardial ischemia, seen in about 2% of aortic root replacements (ARR), is acutely life-threatening, manifesting as failure to wean from bypass, ventricular fibrillation, or unstable hemodynamics. T...Background: Acute myocardial ischemia, seen in about 2% of aortic root replacements (ARR), is acutely life-threatening, manifesting as failure to wean from bypass, ventricular fibrillation, or unstable hemodynamics. The exact precipitating anatomic cause is usually not apparent at the time of surgery. In this report, we take advantage of late computed tomographic (CT) angiograms of long-term survivors of peri-operative ischemia after ARR to determine what abnormalities of the coronary button reattachments produced the peri-operative ischemia. Methods: The database of the Aortic Institute at Yale-New Haven was reviewed to identify all patients undergoing ARR over a 15-year period. Operative records, patient charts, and CT angiograms of patients who had peri-operative ischemia were reviewed in detail, including analysis by an imaging specialist. Results: 271 patients underwent ARR, 220 with mechanical and 51 with biological valved conduits. Hospital mortality was 2.95%. Clinical follow-up ranged from 1 to 182 months. Survival in discharged patients was 97.7% at 5 years and 95.2% at 7 years. Peri-operative ischemia was seen in 4 of 271 patients (1.5%). All four affected patients survived—with interventions including supplemental coronary bypass grafts (4 patients), intra-aortic balloon pump placement (2 patients), and left ventricular assist device insertion (1 patient). Late CT angiograms revealed severe but non-obstructive left main calcification serving as a focal point for coronary angulation in 2 patients, angulation without calcification in 1 patient, and totally normal anatomy in 1 patient. Conclusions: Myo- cardial ischemia after ARR is rare but acutely life-threatening. Prompt recognition and treatment by supplemental coronary artery bypass grafting preserves life and leads to good late survival. Intramural calcification (non-obstructive) of the distal left main coronary artery predisposes to angulation after coronary button creation and should be a “red flag” for this potential problem.展开更多
Since first report of aortic root replacement in 1968, the surgical risk and long term outcome of patients with aortic root aneurysm have been continuously improving. In the last 30 years, the surgical approach is als...Since first report of aortic root replacement in 1968, the surgical risk and long term outcome of patients with aortic root aneurysm have been continuously improving. In the last 30 years, the surgical approach is also evolving towards more valve conservation with prophylactical intervention at an earlier clinical stage. Translational research has also led to emerging surgical innovation and new drug therapy. Their efficacies are currently under vigorous clinical trials and evaluations.展开更多
In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous conditi...In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous condition requires a vigilant eye.Embolic events stemming from infective endocarditis can precipitate acute coronary syndrome,adding another layer of complexity to diagnosis and treatment.展开更多
The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue ...The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue disorders.There are several classifications for BAV,each with its advantages and drawbacks.The condition can lead to valvular malfunction such as regurgitation and stenosis,but is often associated with dilatation of the aortic root,the ascending aorta,the aortic arch,or a combination.Altered flow patterns due to the valve dysfunction as well as the breakdown of elastin in the aortic wall could be responsible for this development.Published surgical series are usually small and research designs vary,which makes the formulation of universal recommendations for treatment difficult.This narrative review provides data from the most recent series in this respect.Often,the condition becomes symptomatic in patients who are about 10 years younger compared to those with a diseased tricuspid aortic valve.The timing of surgery of the valve depends on the degree of its dysfunction.Repair of a dysfunctional BAV should be attempted whenever possible because of the patient’s age.The options for valve repair are summarized,including the need for the use as the effective geometric height.The use of a pericardial patch and the presence of calcified areas of the valve can be predictors for an increased need for reintervention.In those cases,a valve replacement should be preferred.If a dilatation of the ascending aorta or the aortic root is present,this should also be addressed surgically,but the threshold for such a procedure varies.Several techniques are available to treat a dilated ascending aorta and root.For the latter,remodeling and reimplantation can be applied.Depending on the patient’s characteristics,the size of the dilatation,and the affected part,the most appropriate technique should be selected.This requires surgical expertise,which can only be obtained in high-volume centers.展开更多
After type A acute aortic dissection(AAD)repair or modified Bentall procedure,uncontrollable bleeding from the anastomotic sites of the fragile dissected tissues or aortic root area is a critical situation to a cardia...After type A acute aortic dissection(AAD)repair or modified Bentall procedure,uncontrollable bleeding from the anastomotic sites of the fragile dissected tissues or aortic root area is a critical situation to a cardiac surgeon.For postoperative care,lots of blood transfusion with strict monitoring on the patient all night and subsequent reoperation for the bleeding control is usually needed.We managed to make contained local compression of upper half of the heart,from upper part of the right ventricle to just above the innominate vein,using bovine pericardium with closing both sides of transverse sinus in two cases of uncontrolled postoperative bleeding(bleeding from distal anastomotic site in type-A AAD and valve sitting site in modified Bentall procedure).Even though reoperations for the removal of packed gauges were done in both cases 2 days later,postoperative courses at intensive care unit were very smooth with little need for transfusion.This kind of contained local compression trial could be a useful strategy for dealing with the malignant uncontrollable bleeding from the fragile aortic tissue or root area after acute dissection or aortic root repair.展开更多
INTRODUCTION Cardiovascular system involvement is an important determinant of long-term prognosis in patients with systemic lupus erythematosus(SLE).Aneurysmal dilatation of the aortic root combined with Stanford type...INTRODUCTION Cardiovascular system involvement is an important determinant of long-term prognosis in patients with systemic lupus erythematosus(SLE).Aneurysmal dilatation of the aortic root combined with Stanford type A aortic dissection(TAAD)is a highly catastrophic complication in these patients.展开更多
Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by...Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Case Report: A 48-year-old female presented with vague anterior chest discomfort, high blood pressure, systolic-diastolic murmur in the left sternal border with ECG changes of myocardial ischemia. Echocardiography revealed a dilated aortic root with intimal flaps, a leak into the pulmonary artery and regional hypokinesis with contractile dysfunction suggesting a proximal aortic dissection with rupture into the main pulmonary artery. Discussion: The etiology of aortic dissection was mostly hypertension in 80% of cases and aortopathies such as connective tissue disorders, inflammatory and idiopathic. Aortic wall stress is a major trigger of intimal tear and two-dimensional transthoracic echocardiography is an excellent, initial diagnostic gold standard to detect the dissecting flaps, especially in proximal aortic dissection. Conclusion: Blood pressure control is the mainstay of treatment and urgent surgery is indicated in proximal aortic dissection since there is higher chance of rupture with an increase in mortality.展开更多
文摘BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic valve complications.Longterm VSARR durability,especially in BAV patients,is debated.We hypothesize that VSARR outcomes differ between BAV and TAV patients in short-term and long-term settings.AIM To investigate short-term and long-term outcomes of VSARR in BAV vs TAV patients.METHODS This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis included observational studies comparing VSARR in adult BAV vs TAV patients.PubMed,ScienceDirect,and EMBASE were searched from inception to June 2025.Outcomes included mortality,reintervention,and procedural times.Pooled relative risk(RR)and mean differences(MD)with 95%CI were calculated.Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions;evidence certainty via GRADE.RESULTS Thirteen observational studies involving 1419 BAV and 2349 TAV patients were included.In-hospital mortality(RR=0.34,95%CI:0.10-1.14,P=0.08)and reoperation(RR=1.04,95%CI:0.64-1.69,P=0.87)showed no significant differences.All-cause mortality risk was significantly lower in BAV patients(RR=0.34,95%CI:0.13-0.86,P=0.02).Overall reintervention risk was significantly greater in BAV patients(RR=2.64,95%CI:1.96-3.55,P<0.00001).Aortic cross-clamp(MD=3.35 minutes,95%CI:-5.06 to 11.76,P=0.43)and cardiopulmonary bypass times(MD=3.96 minutes,95%CI:-10.26 to 18.18,P=0.59)showed no significant differences but substantial heterogeneity.The certainty of evidence was moderate for reintervention,low for mortality risk and in-hospital reoperation,and very low for procedural times.CONCLUSION VSARR demonstrates comparable short-term safety between BAV and TAV patients.However,BAV patients face a significantly higher long-term reintervention risk,highlighting the need for tailored strategies and further research.
文摘Objective: To measure the calibration of different levels in aortic root andevaluate the relationships between the aortic sinuses and its neighbouring structure. Methods:Thirty heart specimens from cadaver of normal adult were studied. The dimensions of four levels inaortic root were measured and the relationships between the aortic sinues and its neighbouringstructure were observed. Results: The dimensions of four levels in aortic root obtained as follows;Sinus > STJ1 > STJ0 > Base (P < 0.05) . The dimensions of the aortic valve leaflets were measured.The right coronary leaflet was larger than those of the left coronary and noncor-onary leaflets .But there was no statistical signiftcane (P > 0.05) . The relationships between the middle axis ofthe anterior valve of the bicuspid valve and the aortic sinuses were examined. The middle axis ofthe anterior valve in 26 specimens (86.6%) located between the left coronary sinus and thenoncoronary sinus . The relationship between the aortic prominence of the right atrium and theaortic sinuses was examined. The aortic prominence was formed from noncoronary sinus in 22 specimens(73.3%) . The relationship between the middle point of the right and left pulmonary valves and theaortic sinuses was examined. The middle point of the right and left pulmonary valves in 24 specimens(80%) was faced to the point between the right and left aortic sinuses . Conclusion: The dimensionof the four levels in aortic root is as follows, sinus > STJ1 > STJ0 > Base (P < 0.05) . There wasno statistical significance in the size of the three aortic valve leaflets (P > 0.05).
文摘In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sinus with just one trimmed Dacron graft. Between February 2001 and May 2010, we performed partial aortic root remodeling in 40 patients, who underwent emergency surgical intervention. The dissected sinuses were excised leaving a 3-5 mm rim of the aortic wall from the attached aortic valve cusps. A short piece （4-5 cm） of collagen coated woven polyester vascular prosthesis was trimmed with one or two ＂tongues＂ to reconstruct the non-coronary sinus and/ or the right coronary sinus, but without using separated patches. Additional procedures were including hemi-arch replacement in 11 patients, and total arch replacement plus stent-elephant trunk in 20 patients. The mean follow-up time was 36.4~3.6 months. In-hospital mortality was only 5.0% （2/40）; furthermore, 3 （8.6%） patients underwent re-operation of the aortic valve and 2 （5.7%） patients died during follow-up. At the end of follow-up, trivial or no aortic regurgitation was found in 33 patients, but mild aortic regurgitation was found in 2 patients. Our data suggest that the early and mid-term results of partial aortic root remodeling were favorable, and it restored valve durability and function. Thus, the use of technique for root reconstruction in patients with acute type A dissection should be vigorously encouraged.
基金Project (No.2006C33019) supported by the Zhejiang Provincial Science and Technology Foundation of China
文摘Objective:Uric acid(UA) is considered to be a powerful predictor of cardiovascular risk and hyperuricemia might be involved in the metabolic syndrome(MS).This study aims to investigate the relation between UA levels and aortic root dilatation.Methods:A total of 348 hypertensive patients [age(67.5±9.8) years] with or without MS were included in the study.The aortic root diameters at the aortic annulus,the sinuses of Valsalva,the sinotubular junction,and the proximal part of the ascending aorta were measured using a two-dimensional(2D) echocardiography.Serum UA levels were also measured for all patients.Results:A high UA level is independently associated with aortic root diameters at the sinuses of Valsalva(P=0.001) and the proximal ascending aorta(P<0.0001) in the hypertensive patients without MS.In contrast,aortic root diameters were not significantly related to UA levels in the hypertensive patients with MS.Furthermore,increased UA levels were associated with an increased risk for aortic root dilatation in the patients without MS(sex-adjusted hazard ratio 1.75,95% confidence intervals(CI) 1.27-2.41),but not in those with MS.Conclusions:This study demonstrated an independent relationship between the aortic root dimensions and increased levels of serum UA in the hypertensive patients without MS.Further understanding of the mechanisms underlying these associations may allow a clearer interpretation of the potential value of specific urate-lowering treatment on cardiovascular disease.
文摘The Loeys-Dietz syndrome (LDS) is a connective tissue disorder that is associated with vascular abnormalities, including aggressive aortic aneurysms, as well as skeletal and craniofacial malformations. The molecular mechanism of this syndrome remains to be fully elucidated. In this case, we describe a 29-year-old woman, gravida 2 para 1, who was referred for consultation after urinary tract malformations were observed during her mid-gestation anatomic survey. Following referral to our unit, ultrasound examination of the 21-week fetus was repeated. The fetus was observed to have a dilated aortic root and a poorly ossified sternum with mild pectus deformity. After elective termination, single nucleotide polymorphism microarray testing identified a novel 204 kb microdeletion involving the short arm of chromosome 3. The deleted genetic material included 4 exons of the TGFBR2 gene. Although the phenotype of LDS may be caused by haploinsufficiency of the TGFBR1 or TGFBR2 gene, our experience suggests a more complex picture of LDS. The study of such cases might further elucidate its pathogenesis.
文摘The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron<span style="white-space:nowrap;">®</span> tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.
基金This work was supported by the Youth Foundation of Natural Science Foundation of Jiangsu Province(grant number:BK20191069).
文摘Background:The study was aimed at investigating the mathematical relationship between the aortic valve and aortic root through CTA imaging-based reconstruction.Methods:We selected 121 healthy participants and analyzed the measurements of aortic root dimensions,including the sinotubular junction(SJT),ventriculo-arterial junction(VAJ),maximum sinus diameter(SD),sinus height(SH),effective height(eH)and coaptation height(cH).We also reconstructed 3-D aortic valve cusps using CTA imaging to calculate the aortic cusp surface areas.Data were collected to analyze the ratios and the correlation between aortic valve and aortic root dimensions.Results:Among healthy participants,the STJ was approximately 10%larger than the VAJ,and the SD was 1.375 times larger than the VAJ.The average eH and cH were 8.94 mm and 3.62 mm,respectively.The aortic cusp surface areas were larger in men than women.Regardless of sex,the non-coronary cusp was found to be largest,and was fol-lowed by the right coronary cusp and the left coronary cusp.Although the aortic root dimensions were also significantly larger in in men than women,the STJ to VAJ,SD to VAJ,and SH to VAJ ratios did not significantly differ by sex.The mathematical relationship between the aortic cusp surface areas and VAJ orifice area was calculated as aortic cusp surface areas (mm^(2)) =1.512×{VAJ(mm)/2}^(2)×π+166.866. Conclusions:The aortic root has specific geometric ratios.The mathematical relationship between the aortic valve and aortic root might be used to guide aortic valve repair.
文摘Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period. Follow up in the outpatient department suggested all patients had NYHA class I symptoms and anticoagulation with warfarin adjusted to prothrombin time— International normalised ratio. Conclusion: Konno procedure is effective for managing small aortic root as bigger outflow orifice area through the larger valve prosthesis improves ventricular outflow and hence, improves the outcomes.
文摘We describe a case of a 49-year-old man who presented with an uncomplicted aortic root aneurysm, aortic insufficiency, and ST-elevation myocardial infarction (STEMI) without obstructive coronary artery disease on angiography. The computed tomo- graphy angiogram (CTA) of the thorax, performed without cardiac gating, was misinterpreted as normal. In retrospect, an overlooked extravasation of contrast material lateral to the aortic root was detected on non-gating magnetic resonance angiography (MRA). Exploration of the aortic root revealed an unsuspected horizontal intimal tear of the left sinus of Valsalva with limited extramural hematoma. The presence of an otherwise silent intimal tear on preoperative imaging studies makes the overall management more problematic. For example, initiating early broad empirical anticoagulants or fibrinolytics therapy to treat the accompanied myocardial infarction may extend the tear into a full life-threatening aortic dissection, tamponade or rupture. We highlight many of the difficulties associated with the diagnosis and treatment of limited sinus tear when aortic root aneurysm is presenting with cryptogenic STEMI. Accurate morphologic characterization of intimal tear would be best defined with either an electrocardiogram-gating CTA or MRA imagings. These non-invasive tests are needed to make appropriate management decisions. Depending on other pathologic components of aortic root, cusps and the commissural geometry, sinus tear is a critical component for the overall treatment plan and it shifts the surgical intervenetion from valve-sparing operation, commissural resuspension and leaflet repair to composite aortic root replacement (modified version of the Bentall procedure).
文摘Background: Acute myocardial ischemia, seen in about 2% of aortic root replacements (ARR), is acutely life-threatening, manifesting as failure to wean from bypass, ventricular fibrillation, or unstable hemodynamics. The exact precipitating anatomic cause is usually not apparent at the time of surgery. In this report, we take advantage of late computed tomographic (CT) angiograms of long-term survivors of peri-operative ischemia after ARR to determine what abnormalities of the coronary button reattachments produced the peri-operative ischemia. Methods: The database of the Aortic Institute at Yale-New Haven was reviewed to identify all patients undergoing ARR over a 15-year period. Operative records, patient charts, and CT angiograms of patients who had peri-operative ischemia were reviewed in detail, including analysis by an imaging specialist. Results: 271 patients underwent ARR, 220 with mechanical and 51 with biological valved conduits. Hospital mortality was 2.95%. Clinical follow-up ranged from 1 to 182 months. Survival in discharged patients was 97.7% at 5 years and 95.2% at 7 years. Peri-operative ischemia was seen in 4 of 271 patients (1.5%). All four affected patients survived—with interventions including supplemental coronary bypass grafts (4 patients), intra-aortic balloon pump placement (2 patients), and left ventricular assist device insertion (1 patient). Late CT angiograms revealed severe but non-obstructive left main calcification serving as a focal point for coronary angulation in 2 patients, angulation without calcification in 1 patient, and totally normal anatomy in 1 patient. Conclusions: Myo- cardial ischemia after ARR is rare but acutely life-threatening. Prompt recognition and treatment by supplemental coronary artery bypass grafting preserves life and leads to good late survival. Intramural calcification (non-obstructive) of the distal left main coronary artery predisposes to angulation after coronary button creation and should be a “red flag” for this potential problem.
文摘Since first report of aortic root replacement in 1968, the surgical risk and long term outcome of patients with aortic root aneurysm have been continuously improving. In the last 30 years, the surgical approach is also evolving towards more valve conservation with prophylactical intervention at an earlier clinical stage. Translational research has also led to emerging surgical innovation and new drug therapy. Their efficacies are currently under vigorous clinical trials and evaluations.
文摘In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous condition requires a vigilant eye.Embolic events stemming from infective endocarditis can precipitate acute coronary syndrome,adding another layer of complexity to diagnosis and treatment.
文摘The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue disorders.There are several classifications for BAV,each with its advantages and drawbacks.The condition can lead to valvular malfunction such as regurgitation and stenosis,but is often associated with dilatation of the aortic root,the ascending aorta,the aortic arch,or a combination.Altered flow patterns due to the valve dysfunction as well as the breakdown of elastin in the aortic wall could be responsible for this development.Published surgical series are usually small and research designs vary,which makes the formulation of universal recommendations for treatment difficult.This narrative review provides data from the most recent series in this respect.Often,the condition becomes symptomatic in patients who are about 10 years younger compared to those with a diseased tricuspid aortic valve.The timing of surgery of the valve depends on the degree of its dysfunction.Repair of a dysfunctional BAV should be attempted whenever possible because of the patient’s age.The options for valve repair are summarized,including the need for the use as the effective geometric height.The use of a pericardial patch and the presence of calcified areas of the valve can be predictors for an increased need for reintervention.In those cases,a valve replacement should be preferred.If a dilatation of the ascending aorta or the aortic root is present,this should also be addressed surgically,but the threshold for such a procedure varies.Several techniques are available to treat a dilated ascending aorta and root.For the latter,remodeling and reimplantation can be applied.Depending on the patient’s characteristics,the size of the dilatation,and the affected part,the most appropriate technique should be selected.This requires surgical expertise,which can only be obtained in high-volume centers.
文摘After type A acute aortic dissection(AAD)repair or modified Bentall procedure,uncontrollable bleeding from the anastomotic sites of the fragile dissected tissues or aortic root area is a critical situation to a cardiac surgeon.For postoperative care,lots of blood transfusion with strict monitoring on the patient all night and subsequent reoperation for the bleeding control is usually needed.We managed to make contained local compression of upper half of the heart,from upper part of the right ventricle to just above the innominate vein,using bovine pericardium with closing both sides of transverse sinus in two cases of uncontrolled postoperative bleeding(bleeding from distal anastomotic site in type-A AAD and valve sitting site in modified Bentall procedure).Even though reoperations for the removal of packed gauges were done in both cases 2 days later,postoperative courses at intensive care unit were very smooth with little need for transfusion.This kind of contained local compression trial could be a useful strategy for dealing with the malignant uncontrollable bleeding from the fragile aortic tissue or root area after acute dissection or aortic root repair.
文摘INTRODUCTION Cardiovascular system involvement is an important determinant of long-term prognosis in patients with systemic lupus erythematosus(SLE).Aneurysmal dilatation of the aortic root combined with Stanford type A aortic dissection(TAAD)is a highly catastrophic complication in these patients.
文摘Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Case Report: A 48-year-old female presented with vague anterior chest discomfort, high blood pressure, systolic-diastolic murmur in the left sternal border with ECG changes of myocardial ischemia. Echocardiography revealed a dilated aortic root with intimal flaps, a leak into the pulmonary artery and regional hypokinesis with contractile dysfunction suggesting a proximal aortic dissection with rupture into the main pulmonary artery. Discussion: The etiology of aortic dissection was mostly hypertension in 80% of cases and aortopathies such as connective tissue disorders, inflammatory and idiopathic. Aortic wall stress is a major trigger of intimal tear and two-dimensional transthoracic echocardiography is an excellent, initial diagnostic gold standard to detect the dissecting flaps, especially in proximal aortic dissection. Conclusion: Blood pressure control is the mainstay of treatment and urgent surgery is indicated in proximal aortic dissection since there is higher chance of rupture with an increase in mortality.
