1/208. Syphilitic aortic regurgitation. An appraisal of surgical treatment.During the 10 years from 1964 to 1973, fifteen patients with severe syphilitic aortic regurgitation were treated surgically at the National Heart Hospital. In thirteen the valve was replaced and in two it was repaired. In addition four had replacement of an aneurysmal ascending aorta with a Dacron graft and seven some form of plastic repair to the coronary ostia. Three patients died within 1 month of surgery and a further six during the follow-up period which varied from 1 to 55 months (mean 25-5). The six survivors have been followed-up for an average of 33 months. Factors contributing to this high mortality were analysed and it was found that the mean duration of effort dyspnoea was 22 months in the survivors compared with 48 months in those who had died. Similarly the average duration of nocturnal dyspnoea was 4 months in the survivors compared with a mean of 8 months in those who had died. Only six out of the fifteen patients had angina; this was present in two of the survivors and in four of the fatalities. The pulse pressure, heart size, and haemodynamic findings were similar in the two groups. The prognostic value of an elevated erythocyte sedimentation rate was also examined. It was concluded that preoperative investigations should include aortography, coronary arteriography, an assessment of left ventricular function, and whenever possible myocardial biopsy. These data were interpreted as suggesting that patients should be referred for surgery at an earlier stage in the disease--certainly before the onset of cardiac failure and--and that if this more aggresive attitude was adopted, as it has been in non-syphilitic cases of aortic valve disease, the present high mortality in this group would be reduced.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/208. Surgical treatment for a supra sinotubular junctional saccular aneurysm associated with aortic regurgitation.We reported a patient with a saccular ascending aortic aneurysm located just above the non-coronary sinotubular junction. The aneurysm produced severe aortic regurgitation and two episodes of cardiac tamponade. By intraoperative inspection, the border between the aneurysmal wall and non-dilated portion of the normal aortic wall was distinct, and the aortic valve leaflets and aortic annulus appeared normal. aortic valve dysfunction appeared to be caused by dilation of the noncoronary sinotubular junction and mild distortion of the noncoronary sinus because of the aneurysmal formation. We performed patch closure of the aneurysmal ostium and repaired the dilated noncoronary sinotubular junction. Postoperative echocardiography and aortography demonstrated a good coaptation of the aortic valve leaflets with trivial aortic regurgitation. Although a rupture site, dissection or carcinomatous pericarditis which is attributable to the two episodes of cardiac tamponade could not be found, pathologic examination of the aneurysm wall revealed intramural blood leakage between the mucoid degenerated media and notably thickened adventitia. In addition, there was thinning and interruption of the elastic fibers of the media. These findings are consistent with a leaking aneurysm which cause the slow development of cardiac tamponade.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
3/208. Shunt control of bleeding after homograft replacement of the ascending aorta.Homograft replacement of the ascending aorta with replacement of the coronary arteries often is accompanied by significant postoperative bleeding from the suture lines that often requires a second exploratory operation. These events occur despite a meticulous operative technique and pharmacologic hemostatic agents. We used hemostatic material to cover the homograft as patch to create a watertight seal and placed a left-to-right shunt to control bleeding.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
4/208. Severe aortic regurgitation immediately after mitral valve annuloplasty.We report a case of severe aortic regurgitation occurring immediately after the insertion of a mitral annuloplasty ring. On transesophageal echocardiography, regurgitation was found to originate from the retracted left coronary cusp. On direct examination, part of the aortic wall was folded, but no suture could be identified. It was reasoned that tension created by the ring caused the retraction. The problem was corrected by releasing three sutures on the ring. Postoperative course was uneventful.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
5/208. Congenital aortic insufficiency due to aortic cusp stretching: 'kite anomaly'.Aortic insufficiency may be either acquired or congenital. A 46-year-old male had a congenital pathology which resulted in aortic insufficiency due to the presence of a fibrous band that stretched from the non-coronary cusp to the aortic wall. The patient underwent successful aortic valve replacement. At surgery, the fibrous band was stretching the non-coronary cusp so that it prevented coaptation of the aortic valve. The situation was termed by us as the 'kite anomaly'.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
6/208. aortic valve replacement after retrosternal gastric tube reconstruction for esophageal cancer.A 59-year-old man with a history of the thoraco-abdominal esophagus resection with retrosternal gastric tube reconstruction for esophageal cancer complicated by anastomosis leakage and purulent pericarditis was admitted for aortic regurgitation due to infective endocarditis. Floppy vegetation and worsening cardiac failure indicated aortic valve replacement. In a median sternotomy approach, the thickest adhesion between the cervical esophagus and posterior surface of the manubrium sternae was freed using an ultrasonic osteotome. Severe adhesions in the pericardium due to purulent pericarditis were found. Median sternotomy enabled minimal exposure of the aortic root, upper right atrium, and right superior pulmonary vein for instituting extracorporeal circulation and replacing the aortic valve. The patient's postoperative course was uneventful. For cardiac surgery in patients with a retrosternal gastric tube, left anterior or right thoracotomy may be considered to avoid gastric tube injury. Median sternotomy, however, is an alternative enabling safe heart exposure, and the ultrasonic osteotome was very useful in incising the sternum without injuring the cervical esophagus, which had no serosa.- - - - - - - - - - ranking = 0.0045384408906511keywords = circulation (Clic here for more details about this article) |
7/208. Spontaneous dissection of coronary artery in a patient with ascending aortic aneurysm and aortic valve regurgitation.Spontaneous coronary artery dissection is a rare cause of myocardial infarction associated with a significant high morbidity and mortality. It usually occurs in relatively young patients and it is frequently found at autopsy. We report a case of a 42-year-old woman, who underwent resection of subaortic diaphragm ten years earlier presenting with postero-lateral myocardial infarction. Coronary arteriography revealed a dissection of the left main stem extending distally to the left anterior descending artery (LAD) and circumflex artery (Cx); occlusion of the postero-lateral branch of the Cx; severe aortic valve regurgitation and ascending aortic aneurysm. She was successfully operated on in emergency and underwent myocardial revascularization and separate replacement of the aortic valve and the ascending aorta. In this specific case of coronary dissection and severe aortic regurgitation it is mandatory to perform surgery in emergency to limit infarction evolution and avert loss of life.- - - - - - - - - - ranking = 3keywords = coronary (Clic here for more details about this article) |
8/208. Acute heart failure due to local dehiscence of aortic wall at aortic valvular commissure.Spontaneous dehiscence of the aortic wall at the aortic commissure is not recognized as one of the usual pathological causes of aortic regurgitation. We describe the case of a 56-year-old man with hypertension, who experienced acutely progressive congestive heart failure due to massive aortic regurgitation. Local layer dehiscence around the commissure was noted with partial detachment of the commissure resulting in the loss of commissural support with secondary rupture of a non-coronary cusp, which led to massive aortic regurgitation.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
9/208. A case of aortic dissection with transient ST-segment elevation due to functional left main coronary artery obstruction.A 48-year-old man with a history of hypertension and diabetes mellitus was hospitalized with sudden onset of severe chest pain. He was in cardiogenic shock with a systolic pressure of 60 mm Hg. His electrocardiogram (ECG) showed ST-segment elevation in the precordial leads suggestive of acute anteroseptal myocardial infarction. The ST-segment returned to baseline after the systolic blood pressure rose to 100 mm Hg with the administration of sympathomimetic agents. aortography and transesophageal echocardiography demonstrated type A aortic dissection and aortic regurgitation. aortography and short-axis transesophageal echocardiography showed during diastole almost complete collapse of the true lumen of the ascending aorta caused by the intimal flap. The patient underwent surgical repair of the aortic dissection and implantation of Palmaz stents in the carotid arteries. Decreased blood pressure and the presence of aortic regurgitation accelerated the collapse of the true lumen during diastole in the ascending aorta, resulting in functional obstruction of the left main coronary artery, which may have been related to ST-segment changes in this case.- - - - - - - - - - ranking = 2.5keywords = coronary (Clic here for more details about this article) |
10/208. Composite graft tear and aortico-left ventricular tunnel after aortic root replacement using Cabrol's technique.Woven graft tera is a very rare complication after aortic root replacement using Cabrol's technique. In this report, we present a 40-year-old man with aortic annular ectasia and severe aortic regurgitation who underwent four revisional aortic valve operations because of recurrent paravalvular leakage after valve repair and/or replacement. The Bentall operation with translocated aortic valve and Cabrol's coronary artery anastomosis were performed in the fifth operation, because of progressive dilatation of the aortic root and ascending aorta. Unfortunately, aortico-ventricular tunnel developed 2 years after aortic root replacement using Cabrol's technique. Graft tear and proximal anastomotic leakage were found to be the cause of the tunnel during the sixth operation. The patient died of myocardial failure 8 days after the seventh aortic root replacement operation. The devastating result of this complication should alert cardiovascular surgeons to the possibility of graft failure after the Bentall operation.- - - - - - - - - - ranking = 0.5keywords = coronary (Clic here for more details about this article) |
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