Résumé
A 60-year-old man complained of palpitation due to transitory atrial fibrillation. The annulo-aortic ectasia was recognized, and was getting enlarged to 52 mm. After an additional examination, membranous ventricular septal aneurysm was revealed. There was no evidence of thrombus, shunt, or infection in the membranous ventricular septal aneurysm. The valve-sparing aortic root replacement (reimplantation) and the patch-closure of the membranous ventricular septal aneurysm were performed. Stabilizing the subannular tissue by a Dacron patch made the reimplantation technique feasible. To secure a subannular suture line, 3 mattress stitches were passed inside-out through the Dacron patch, the fibrous rim of the membranous septum and the prosthetic graft again. He was discharged without any complication 12 days after the operation.
Résumé
A 52-year-old man with annulo-aortic ectasia and DeBakey's type IIIb dissecting aortic aneurysm was successfully treated. Aortography showed moderate to severe aortic regurgitation and enlargement of the ascending aorta, and CT showed a huge type IIIb dissecting aortic aneurysm. We scheduled a two-staged operation because dissection occurred 6 months previously and ECG showed severe LVH and ST-T change. The aortic root replacement using Bentall's procedure was performed, which was followed by arch replacement with an elephant trunk prosthesis on distal aorta. The entry in the distal aortic arch was covered by an elephant trunk prosthesis and postoperative diagnostic images showed thrombo-occlusion of the false lumen in the descending aorta. This operation was safe and might be a useful method for annulo-aortic ectasia with type IIIb dissecting aortic aneurysm.
Résumé
A 61-year-old woman was admitted to our hospital because of acute heart failure. The angiogram showed an enlarged aortic root and aortic incompetence which indicated annulo-aortic ectasia. An aortic valve-sparing operation was impossible because of severe prolapse of the aortic valve and the patient hesitated to have anti-coagulation therapy. Thus we performed aortic root replacement with the Freestyle™ stentless porcine valve (Medtronic Inc.). We plicated each original commissure in order to narrow the enlarged annulus and attach the Freestyle valve to the annulus directly by continuous suture. There was no significant difference in surgical technique and aortic cross-clamping time, compared to conventional operation. Aortic root replacement with the Freestyle valve seems an attractive option especially for elderly patients or cases in which of contraindicated for anti-coagulation therapy.