ABSTRACT
Many surgical techniques have been described either to repair and to replace the aortic valve. Among the paediatric population the potential for growth has to be preserved and valve reconstruction is therefore of great importance. In the last two years 25 consecutive patients, mean age 8.6 years, with aortic valve disease, underwent aortic valve repair for aortic regurgitation (AR) (10 patients), aortic valve stenosis (5 patients) or mixed lesion (10 patients). None of the patients died neither during hospitalization nor at follow-up (median 9.25 months). In the aortic stenosis (AS) group, one patient required reoperation (re-repair). None of the patients in the AR group developed more than mild AS and mild AR during follow-up. Nine out of 10 patients of the mixed lesion group had no or trivial AR at the follow-up. Left ventricular dimension decreased in all patients after repair. With a better understanding of the causes of AS or AR and the adoption of different techniques, often used in multiple association, we believe that aortic valve repair can be achieved in most patients with a normal left ventricular outflow tract.
Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Cardiac Surgical Procedures , Adolescent , Adult , Aortic Valve/abnormalities , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/physiopathology , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Cardiac Surgical Procedures/adverse effects , Child , Child, Preschool , Echocardiography, Transesophageal , Female , Humans , Infant , Male , Retrospective Studies , Severity of Illness Index , Time Factors , Treatment Outcome , Ventricular Function, Left , Young AdultABSTRACT
The association of a bicuspid aortic valve (BAV) with abnormalities of the proximal thoracic aorta, including dilatation, aneurysm and dissection, has been previously described, leading to the hypothesis of a common underlying developmental defect involving the aortic valve and the aortic wall. Consequently, any patient with BAV should receive a careful assessment not only of the valve function, but also of the aortic root and the ascending aorta. Dilatation of the proximal thoracic aorta is a common finding in patients with BAV and is believed to be related to aortic rupture and dissection. Because progressive dilatation can occur, careful long-term surveillance of the aortic dimensions is required. Prophylactic surgical repair of the dilated aorta should be recommended more aggressively for patients with BAV than for those with a tricuspid aortic valve. However, the optimal timing of aortic surgery in BAV patients remains uncertain because of the limited data available on the natural history of asymptomatic aortic dilatation.
Subject(s)
Aorta, Thoracic/abnormalities , Aortic Diseases/congenital , Aortic Valve/abnormalities , Heart Defects, Congenital/epidemiology , Heart Valve Diseases/congenital , Aortic Diseases/epidemiology , Aortic Diseases/physiopathology , Aortic Diseases/surgery , Child , Dilatation, Pathologic , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/surgery , Heart Valve Diseases/epidemiology , Heart Valve Diseases/physiopathology , Heart Valve Diseases/surgery , Humans , PrevalenceABSTRACT
The dimensions of the entire aorta at different anatomic levels were measured by transthoracic 2-dimensional echocardiography in 162 consecutive patients with isolated bicuspid aortic valves (BAVs) without significant aortic valve dysfunction. Aortic dilation involved the aortic root and the ascending aorta but was not present in the descending and abdominal aorta. A significant increase in the dimensions of the aortic arch was found in patients with BAVs aged >40 years. Ascending aortic diameter and the extension of aortic dilation were significantly correlated with age, but no correlation was found between aortic dimensions and aortic valve morphology.
