The clinical results of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To analyze the clinical effect of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection. Methods    From January 2010 to December 2015, 30 patients (25 males, 5 females) underwent partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection with involvement of aortic root. The range of age was from 27 to 72 years, and the mean age was 51.2±8.0 years. The proximal aortic dissection received partial aortic root remodeling, and the operation procedures included partial aortic root remodeling+ascending aortic replacement in 9 patients, partial aortic root remodeling+ascending aortic replacement+hemi-arch replacement in 6 patients, partial aortic root remodeling+ascending aortic replacement+Sun's procedure in 15 patients. The patients were followed up for 10 to 60 months with a mean of 37.9±3.2 months. Preoperative and postoperative degrees of aortic regurgitation were compared. Results    All patients survived from the operation, and one patient died from severe pulmonary infection 15 days after operation. The overall survival rate was 96.7% (29/30). One patient died during the follow-up. Two patients underwent aortic valve replacement in the 12th and 15th postoperative month respectively because of severe aortic regurgitation (AI). Up to the last follow-up, trivial or no aortic regurgitation was demonstrated in 24 patients, but mild aortic regurgitation occurred in 2 patients. Conclusion    The surgical treatment for aortic root pathology due to Stanford type A aortic dissection is challenging, and partial aortic root remodeling operations could restore valve durability and function, and obtains the early- and mid-term results.

A Case of Partial Aortic Root Remodeling for the Right Sinus of Valsalva Aneurysm with an Anomalous Origin of the Coronary Artery / 日本心臓血管外科学会雑誌

A sinus of Valsalva aneurysm is a rare cardiac disorder, and reports of it with an anomalous origin of the coronary artery are scarce. A 35-year-old male was admitted to our department with fatigue and cough. Multi-detector-row computer tomography (MDCT) revealed an isolated extracardiac right sinus of Valsalva aneurysm with an anomalous origin of the left circumflex artery (LCX) and total occlusion of the right coronary artery (RCA). Its diameter was about 70 mm. We performed a partial aortic root remodeling procedure with a trimmed J-graft because he had neither aortic regurgitation (AR) nor annuloaortic ectasia (AAE). Concomitantly, coronary artery bypass grafting to the RCA (Seg. 3) using a saphenous vein, and reconstruction of the LCX by Piehler's technique using a saphenous vein were added. The patient's postoperative course was uneventful, and he was discharged on the 28th postoperative day. Postoperative MDCT revealed that the aneurysm of the right sinus of Valsalva was not enhanced, and the RCA and LCX were patent. This procedure preserved the patient's own normal aortic valve and sinus of Valsalva and enables him to have more physiologically normal hemodynamics than aortic root reconstruction using a composite graft, e.g. Bentall procedure, Cabrol procedure, although the potential progression of the AR requires careful follow-up.

A Case of Partial Aortic Root Remodeling for Aneurysm of the Right Coronary Sinus of Valsalva / 日本心臓血管外科学会雑誌

We report a case of aneurysm located at the right sinus of Valsalva with mild aortic regurgitation (AR). The patient was a 55-year-old man with hypertension. When he consulted a local doctor complaining of back pain, aneurysm of right sinus of Valsalva was unexpectedly diagnosed by detailed examinations. He was transferred to our hospital for surgery. An echocardiogram showed mild aortic regurgitation and enlargement of the right sinus of Valsalva. Computed tomography demonstrated an unruptured and extracardiac aneurysm of the right sinus of Valsalva (diameter, 45 mm) and a right coronary artery (RCA) that originated from just above the ostium of the aneurysm. He underwent a partial aortic root remodeling procedure with trimmed Hemashield graft and the RCA was anastomosed to the Hemashield graft by the Carrel patch technique. The postoperative course was uneventful, and he was discharged on the 12th postoperative day. Postoperative angiography revealed that aneurysm of the right sinus of Valsalva was not enhanced and the RCA was patent. This procedure preserve the patient's own aortic valve and normal sinus of Valsalva and enabled him to have more physiologic hemodynamics than patch closure, although progression of the AR requires careful follow-up.