A case report of atypical coarctation of the aortic arch with thoracic aortic aneurysm

A 30-year-old woman was admitted to our hospital because of the abnormal shadow on chest X ray film and paralysis of right fingers. The preoperative aortogram and DSA showed atypical coarctation of the aortic arch with thoracic aortic aneurysm. We successfully performed extra-anatomical bypass with a 14 mm Cooley low porosity Ducron graft between ascending aorta and discending aorta. Her postoperative course was uneventful and discharged one month after the operation.     

A case report of aortic and mitral regurgitation combined with ankylosing spondylosis

The purpose of this communication is to present a successful case of surgical treatment of aortic and mitral valve regurgitation associated with ankylosing spondylosis. A 48-year-old male was admitted with symptoms of palpitation and shortness of breath. His heart murmur had been pointed out for 4 months prior to this admission. His previous history did not show any evidence of rheumatic heart disease. Retrograde aortography showed moderate to severe aortic valvular regurgitation and echocardiography revealed mitral valve regurgitation with minor degree. At the same time he complained of rigidity of neck muscle as well as back pain for last 15 years. He underwent aortic valve replacement and mitral valve was left alone. His postoperative course was uneventful. In Japan, aortic valve regurgitation associated with ankylosing spondylosis has been reported to be very rare compared to the European or American people. Several important features in the diagnosis and operative treatment for this combination of diseases have been also discussed.     

Traumatic aortic regurgitation with an ascending aortic aneurysm: report of a case

We reported a case of an aortic regurgitation due to nonpenetrating chest trauma with an ascending aortic aneurysm. A 58-year-old man was admitted to our hospital with an acute left cardiac failure. Severe aortic regurgitation and ascending aortic aneurysm were diagnosed on ultrasonic echocardiography (UCG) and computed tomography (CT) scan. On the 13th day after the injury, semi-emergency operation was done. The commissure between the right coronary and non-coronary cups was torn, and modified Bentall operation was performed. The patient recovered well and discharged uneventfully.     

A case report of perforated aneurysm of mitral valve with aortic regurgitation

The patient was a 71-year-old male who complained of palpitation and tachycardia. The echocardiogram showed a bulging of the anterior mitral valve leaflet toward the left atrium that persisted throughout cardiac cycle. The cine angiogram showed deformity of the anterior mitral valve leaflet with severe mitral regurgitation and mild aortic regurgitation. At operation, a perforated aneurysm was recognized at the anterior mitral valve leaflet without thrombus and vegetation. The size of aneurysm was 40 x 25 x 25 mm. The patient underwent MVR + AVR, and the postoperative course was uneventful. Pathological examination of the anterior mitral valve leaflet revealed scar-like fibrosis and old inflammatory change. It was judged a true aneurysm of mitral valve, because the structure of endocardium was kept.     

A surgical case of atypical aortic coarctation using cardiopulmonary bypass.

We report a 44-year-old woman with atypical aortic coarctation accompanied by cerebral artery disease. She was hospitalized for vertigo. An extra-anatomic bypass between the ascending aorta and abdominal aorta was performed using partial cardiopulmonary bypass under moderate hypothermia to reduce the after load of the left ventricle and maintain cerebral blood flow and cerebral perfusion pressure. The postoperative course was uneventful and there was no postoperative neurological deficiency.     

Simultaneous transcatheter treatment of ascending aortic aneurysm with aortic and mitral regurgitation: an in vitro study

 Open in a separate windowOBJECTIVESWe sought to explore the efficacy of the endovascular repair of an ascending aortic aneurysm with aortic and mitral regurgitation by 2 novel valved stents.METHODSWe established models of ascending aortic aneurysms combined with aortic and mitral regurgitation in 10 pig hearts, then implanted self-expanding aortic fenestrated and mitral valved stents via the transapical approach. We applied a fluoroscopy-guided in vitro setting to test the approach, then analysed continuous circulating flushing at 37°C. Finally, we determined operating times, echocardiography and changes of coronary flow as well as fenestration alignment with the coronary ostia.RESULTSThis approach resulted in a 100% overall technical success rate, excellent handling properties and precise positioning. The time taken to implant the 2 valved stents was 59 ± 12 min. Flow of the left and right coronary arteries did not significantly decrease after the stents were implanted (330.4 ± 12.06 ml/min vs 289.4 ± 5.29 ml/min, P < 0.001; 376.8 ± 10.5 ml/min vs 350.0 ± 14.5 ml/min; P < 0.001). We found no obvious regurgitation and perivalvular leakage; nor did the gradients of the aortic and mitral valves as well as of the left ventricular outflow tract increase significantly. The final angiographic examination and profile of the coronary opening confirmed the good position of the valved stents, the exclusion of the aneurysm and the patency of both coronary arteries.CONCLUSIONSThese findings indicate the potential for combined transcatheter aortic root and mitral valve replacement in treating aortic root pathologies. In future, in vivo studies are expected to validate this approach and ascertain its durability.     

A case of combined operation of aortic valve slicing and root remodeling for ascending aortic aneurysm with aortic regurgitation]

A 56-year-old female admitted with severe back pain, and her chest computed tomography demonstrated non-dissecting sclerotic aneurysm of the ascending aorta. Aortography and echocardiography showed marked dilatation of the ascending aorta and the Valsalva sinuses resulting in disappearance of the sinotubular junction. Aortic regurgitation of grade three was, also, recognized. A combined operation of aortic valve slicing of the right and the left coronary cusps and aortic root remodeling (Yacoub's method) was successfully performed. A woven Dacron double-veloured graft (Hemashield) of 22 mm in diameter was used for reconstruction of the ascending aorta and its root. Postoperative aortography figured the new sinotubular junction and the new Valsalva-like sinus composed by the graft, and aortic regurgitation was controlled to grade one.     

Balloon dilatation of aortic coarctation]

Endovascular balloon dilatation of coarctation of the aorta is a manipulation for radical correction of the anomaly with an evident hemodynamic effect in patients with the isolated form, in combination of coarctation of the aorta with aortic stenosis, and in atypical forms of the anomaly. Up to 90% of good immediate results were produced among these patients. Balloon dilatation may also be conducted in recoarctation after the traditional surgical management. Being devoid of some of the negative factors of the accepted methods of treatment, endovascular angioplasty is a sparing and a relatively safe method. Paradoxical hypertension does not develop as a rule. Rare complications in the zone of the approach were encountered. Balloon dilatation may be combined with endovascular correction of other anomalies, and may be repeated many times. In recoarctation and atypical forms of the anomaly balloon dilatation helps in avoiding complex and dangerous operations using the traditional methods. Coarctation in the form of a diaphragm is the most "favourable" type of the anomaly for balloon dilatation. The operation is also indicated in coarctation in patients with hypoplasia of the arch and isthmus, despite its palliative character.     

Thoracoabdominal aortic replacement for abdominal aortic aneurysm with atypical coarctation of thoracoabdominal aorta following mitral valve plasty.

We successfully treated a case of a 65-year-old female with an abdominal aortic aneurysm coexisting with an atypical coarctation of thoracoabdominal aorta and celiac axis and superior mesenteric artery occlusion. A dilated inferior mesenteric artery was supplying the celiac artery and superior mesenteric artery regions. The patient also had mitral regurgitation. After a mitral valve plasty, we repaired the abdominal aortic aneurysm and the atypical coarctation of the thoracoabdominal aorta using partial extracorporeal circulation, segmental clamping, and a selective perfusion of both the bilateral renal artery and dilated inferior mesenteric artery. The patient had an uneventful hospital course and remains well.     

Surgical correction of atypical aortic coarctation with hypertension

Atypically localised coarctation of the aorta is one of the very rare pathological findings. Hypertension of unknown aetiology, atypical vascular sounds, and symptoms of collateral circulation are indicative for diagnosis. Vascular surgery is justified in any case by the juvenile age of the patients concerned and by poor quoad vitam prognosis. Generally, surgical intervention should be undertaken with patients between eight and 14 years of age. Surgical methods and results are reported.     

A case of quadricuspid aortic valve with aortic regurgitation

A 67-year-old man with grade 3 aortic valve regurgitation was found to have a quadricuspid aortic valve. The aortic valve consisted of 1 large, 2 intermediate and 1 small sized cusp. An accessory cusp located between the right and noncoronary cusps, and shaped like a hammock which sling by the fibrous strings originating from the both commissures to the aortic wall. Aortic valve replacement was successfully performed with a 23 mm St. Jude Medical prosthetic valve, and the patient is asymptomatic five months post-operatively. Histological examination of the resected cusps showed fibrous thickening and no rheumatic valvulitis or infective endocarditis.     

Single-stage repair of aortic coarctation with concomitant bicuspid aortic valve and ascending aortic aneurysm

The optimal surgical management of patients presenting with an aortic coarctation together with other cardiovascular disorders is unclear. In this study, we report the case of an adult male with an aortic coarctation associated with a bicuspid aortic valve and an ascending aortic aneurysm. The patient underwent single-stage repair involving the Bentall technique and total arch replacement combined with stented elephant trunk implantation, which was performed through median sternotomy. We consider this procedure to be a suitable alternative for treating these complex cases.     

A successful repair of intraoperative retrograde type A aortic dissection in a patient with aortic regurgitation and ascending aortic aneurysm

The patient was a 67-year-old male with aortic regurgitation and ascending aortic aneurysm. We noticed the type A retrograde aortic dissection occurring from the cannulation site through the right femoral artery. We discontinued cardio-pulmonary bypass immediately, and established selective cerebral perfusion (SCP) eleven minutes after retrograde cerebral perfusion (RCP). We underwent simultaneous aortic valve replacement and ascending and arch graft replacement with an aid of SCP combined with RCP and systemic low flow perfusion. Postoperative course was satisfactory, although patient had a transient neurologic deficit. Intraoperative aortic dissection is a rare but potentially fatal complication. RCP may be a simple and useful method in emergency operation for intraoperative retrograde type A aortic dissection to avoid serious cerebral damage.     

升主动脉置换术或成形术治疗主动脉瓣病变合并的升主动脉瘤样扩张

目的 对比分析主动脉瓣病变合并升主动脉瘤扩张在行主动脉瓣置换术(AVR)的同时施行升主动脉置换术(A组)或成形术(B组)的结果,探讨两种方法的临床效果及适应证.方法 A、B两组术前年龄、性别、心功能分级、主动脉瓣病变、左室射血分数等差异均无统计学意义.A组主动脉直径(49.45±3.96)mm,B组(49.31±3.68)mm,差异亦无统计学意义.行AVR后A组常规置换升主动脉,B组纵行切除部分升主动脉壁,缝合后包裹28～30 mm人工血管.结果 A、B两组术后均无死亡.A组主动脉阻断(71.70±17.13)min、体外循环(110.52±27.51)min,均明显大于B组的(57.13±16.32)min(P=0.025)和(97.31±19.46)min(P=0.004).两组术中及术后输血量、并发症发生率差异无统计学意义.结论 主动脉瓣病变合并升主动脉瘤样扩张,年轻病人主动脉直径≥40 mm时应积极手术处理扩张的升主动脉.升主动脉成形术,同时外包裹人工血管的方法较升主动脉置换术更为简单、安全,但升主动脉壁必须无粥样硬化或溃疡.