In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sin...In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sinus with just one trimmed Dacron graft. Between February 2001 and May 2010, we performed partial aortic root remodeling in 40 patients, who underwent emergency surgical intervention. The dissected sinuses were excised leaving a 3-5 mm rim of the aortic wall from the attached aortic valve cusps. A short piece （4-5 cm） of collagen coated woven polyester vascular prosthesis was trimmed with one or two ＂tongues＂ to reconstruct the non-coronary sinus and/ or the right coronary sinus, but without using separated patches. Additional procedures were including hemi-arch replacement in 11 patients, and total arch replacement plus stent-elephant trunk in 20 patients. The mean follow-up time was 36.4~3.6 months. In-hospital mortality was only 5.0% （2/40）; furthermore, 3 （8.6%） patients underwent re-operation of the aortic valve and 2 （5.7%） patients died during follow-up. At the end of follow-up, trivial or no aortic regurgitation was found in 33 patients, but mild aortic regurgitation was found in 2 patients. Our data suggest that the early and mid-term results of partial aortic root remodeling were favorable, and it restored valve durability and function. Thus, the use of technique for root reconstruction in patients with acute type A dissection should be vigorously encouraged.展开更多
Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargem...Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period. Follow up in the outpatient department suggested all patients had NYHA class I symptoms and anticoagulation with warfarin adjusted to prothrombin time— International normalised ratio. Conclusion: Konno procedure is effective for managing small aortic root as bigger outflow orifice area through the larger valve prosthesis improves ventricular outflow and hence, improves the outcomes.展开更多
Objective: To measure the calibration of different levels in aortic root andevaluate the relationships between the aortic sinuses and its neighbouring structure. Methods:Thirty heart specimens from cadaver of normal a...Objective: To measure the calibration of different levels in aortic root andevaluate the relationships between the aortic sinuses and its neighbouring structure. Methods:Thirty heart specimens from cadaver of normal adult were studied. The dimensions of four levels inaortic root were measured and the relationships between the aortic sinues and its neighbouringstructure were observed. Results: The dimensions of four levels in aortic root obtained as follows;Sinus > STJ1 > STJ0 > Base (P < 0.05) . The dimensions of the aortic valve leaflets were measured.The right coronary leaflet was larger than those of the left coronary and noncor-onary leaflets .But there was no statistical signiftcane (P > 0.05) . The relationships between the middle axis ofthe anterior valve of the bicuspid valve and the aortic sinuses were examined. The middle axis ofthe anterior valve in 26 specimens (86.6%) located between the left coronary sinus and thenoncoronary sinus . The relationship between the aortic prominence of the right atrium and theaortic sinuses was examined. The aortic prominence was formed from noncoronary sinus in 22 specimens(73.3%) . The relationship between the middle point of the right and left pulmonary valves and theaortic sinuses was examined. The middle point of the right and left pulmonary valves in 24 specimens(80%) was faced to the point between the right and left aortic sinuses . Conclusion: The dimensionof the four levels in aortic root is as follows, sinus > STJ1 > STJ0 > Base (P < 0.05) . There wasno statistical significance in the size of the three aortic valve leaflets (P > 0.05).展开更多
The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imag...The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron<span style="white-space:nowrap;">®</span> tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.展开更多
Transcatheter aortic valve replacement(TAVR)has been performed for nearly 20years,with reliable safety and efficacy in moderate-to high-risk patients with aortic stenosis or regurgitation,with the advantage of less tr...Transcatheter aortic valve replacement(TAVR)has been performed for nearly 20years,with reliable safety and efficacy in moderate-to high-risk patients with aortic stenosis or regurgitation,with the advantage of less trauma and better prognosis than traditional open surgery.However,because surgeons have not been able to obtain a full view of the aortic root,3-dimensional printing has been used to reconstruct the aortic root so that they could clearly and intui-tively understand the specific anatomical structure.In addition,the 3D printed model has been used for the in vitro simulation of the planned procedures to predict the potential complications of TAVR,the goal being to provide guidance to reasonably plan the procedure to achieve the best outcome.Postprocedural 3D printing can be used to understand the depth,shape,and distribution of the stent.Cardiovascular 3D printing has achieved remarkable results in TAVR and has a great potential.展开更多
Since first report of aortic root replacement in 1968, the surgical risk and long term outcome of patients with aortic root aneurysm have been continuously improving. In the last 30 years, the surgical approach is als...Since first report of aortic root replacement in 1968, the surgical risk and long term outcome of patients with aortic root aneurysm have been continuously improving. In the last 30 years, the surgical approach is also evolving towards more valve conservation with prophylactical intervention at an earlier clinical stage. Translational research has also led to emerging surgical innovation and new drug therapy. Their efficacies are currently under vigorous clinical trials and evaluations.展开更多
目的:探讨二叶式主动脉瓣狭窄患者主动脉根部形态学特点对经导管主动脉瓣置换术(TAVR)疗效的影响。方法:回顾性选取2014年1月至2016年12月在阜外医院、四川大学华西医院及浙江大学附属第二医院行TAVR的二叶式主动脉瓣狭窄患者49例。分...目的:探讨二叶式主动脉瓣狭窄患者主动脉根部形态学特点对经导管主动脉瓣置换术(TAVR)疗效的影响。方法:回顾性选取2014年1月至2016年12月在阜外医院、四川大学华西医院及浙江大学附属第二医院行TAVR的二叶式主动脉瓣狭窄患者49例。分析患者主动脉根部形态学特点、手术有效性及安全性,并进行随访。结果:二叶式主动脉瓣无嵴与带嵴类型占比相当(55.1%vs 44.9%),瓣叶钙化程度重[钙化体积HU850=(604.1±318.7) mm^3],平均瓣环周长大于平均瓣环上水平周长[(78.8±7.4) mm vs (67.1±6.7) mm,P<0.001],平均左心室流出道(LVOT)周长大于平均瓣环周长[(81.6±10.5) mm vs (78.8±7.4) mm,P=0.003]。置入瓣中瓣患者12例(24.5%),瓣膜置入过深患者14例(34.1%)。置入瓣中瓣患者比无瓣中瓣患者瓣环平均内经[(26.8±2.4) mm vs(23.9±2.0) mm,P<0.001]、周长[(85.7±7.0) mm vs (76.6±6.1) mm,P<0.001]及LVOT平均内径[(28.4±2.7) mm vs (24.3±3.1) mm,P<0.001]、周长[(91.3±9.1) mm vs (78.4±8.9) mm,P<0.001]更大,LVOT周长/瓣环上水平周长比值虽差异无统计学意义[(125.5±12.3)%vs (119.4±15.7)%,P=0.067],但趋近阈值。瓣膜置入过深患者比无置入过深患者LVOT周长/瓣环周长比值更大[(108.0±7.4)%vs (101.2±6.7)%,P=0.005]。结论:二叶式主动脉瓣患者的瓣环和LVOT平均内径及LVOT周长/瓣环周长比值对于TAVR中瓣中瓣的置入及瓣膜置入深度具有一定影响。展开更多
文摘In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sinus with just one trimmed Dacron graft. Between February 2001 and May 2010, we performed partial aortic root remodeling in 40 patients, who underwent emergency surgical intervention. The dissected sinuses were excised leaving a 3-5 mm rim of the aortic wall from the attached aortic valve cusps. A short piece （4-5 cm） of collagen coated woven polyester vascular prosthesis was trimmed with one or two ＂tongues＂ to reconstruct the non-coronary sinus and/ or the right coronary sinus, but without using separated patches. Additional procedures were including hemi-arch replacement in 11 patients, and total arch replacement plus stent-elephant trunk in 20 patients. The mean follow-up time was 36.4~3.6 months. In-hospital mortality was only 5.0% （2/40）; furthermore, 3 （8.6%） patients underwent re-operation of the aortic valve and 2 （5.7%） patients died during follow-up. At the end of follow-up, trivial or no aortic regurgitation was found in 33 patients, but mild aortic regurgitation was found in 2 patients. Our data suggest that the early and mid-term results of partial aortic root remodeling were favorable, and it restored valve durability and function. Thus, the use of technique for root reconstruction in patients with acute type A dissection should be vigorously encouraged.
文摘Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period. Follow up in the outpatient department suggested all patients had NYHA class I symptoms and anticoagulation with warfarin adjusted to prothrombin time— International normalised ratio. Conclusion: Konno procedure is effective for managing small aortic root as bigger outflow orifice area through the larger valve prosthesis improves ventricular outflow and hence, improves the outcomes.
文摘Objective: To measure the calibration of different levels in aortic root andevaluate the relationships between the aortic sinuses and its neighbouring structure. Methods:Thirty heart specimens from cadaver of normal adult were studied. The dimensions of four levels inaortic root were measured and the relationships between the aortic sinues and its neighbouringstructure were observed. Results: The dimensions of four levels in aortic root obtained as follows;Sinus > STJ1 > STJ0 > Base (P < 0.05) . The dimensions of the aortic valve leaflets were measured.The right coronary leaflet was larger than those of the left coronary and noncor-onary leaflets .But there was no statistical signiftcane (P > 0.05) . The relationships between the middle axis ofthe anterior valve of the bicuspid valve and the aortic sinuses were examined. The middle axis ofthe anterior valve in 26 specimens (86.6%) located between the left coronary sinus and thenoncoronary sinus . The relationship between the aortic prominence of the right atrium and theaortic sinuses was examined. The aortic prominence was formed from noncoronary sinus in 22 specimens(73.3%) . The relationship between the middle point of the right and left pulmonary valves and theaortic sinuses was examined. The middle point of the right and left pulmonary valves in 24 specimens(80%) was faced to the point between the right and left aortic sinuses . Conclusion: The dimensionof the four levels in aortic root is as follows, sinus > STJ1 > STJ0 > Base (P < 0.05) . There wasno statistical significance in the size of the three aortic valve leaflets (P > 0.05).
文摘The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron<span style="white-space:nowrap;">®</span> tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.
基金This work was supported by the National Key R&D Program of China(No.2020YFC2008100)the Shaanxi Province Innovation Capability Support Plan-Innovative Talent Promotion Plan(No.2020TD-034)the Discipline Boosting Program of Xijing Hospital(No.XJZT18MJ69).
文摘Transcatheter aortic valve replacement(TAVR)has been performed for nearly 20years,with reliable safety and efficacy in moderate-to high-risk patients with aortic stenosis or regurgitation,with the advantage of less trauma and better prognosis than traditional open surgery.However,because surgeons have not been able to obtain a full view of the aortic root,3-dimensional printing has been used to reconstruct the aortic root so that they could clearly and intui-tively understand the specific anatomical structure.In addition,the 3D printed model has been used for the in vitro simulation of the planned procedures to predict the potential complications of TAVR,the goal being to provide guidance to reasonably plan the procedure to achieve the best outcome.Postprocedural 3D printing can be used to understand the depth,shape,and distribution of the stent.Cardiovascular 3D printing has achieved remarkable results in TAVR and has a great potential.
文摘Since first report of aortic root replacement in 1968, the surgical risk and long term outcome of patients with aortic root aneurysm have been continuously improving. In the last 30 years, the surgical approach is also evolving towards more valve conservation with prophylactical intervention at an earlier clinical stage. Translational research has also led to emerging surgical innovation and new drug therapy. Their efficacies are currently under vigorous clinical trials and evaluations.
文摘目的:探讨二叶式主动脉瓣狭窄患者主动脉根部形态学特点对经导管主动脉瓣置换术(TAVR)疗效的影响。方法:回顾性选取2014年1月至2016年12月在阜外医院、四川大学华西医院及浙江大学附属第二医院行TAVR的二叶式主动脉瓣狭窄患者49例。分析患者主动脉根部形态学特点、手术有效性及安全性,并进行随访。结果:二叶式主动脉瓣无嵴与带嵴类型占比相当(55.1%vs 44.9%),瓣叶钙化程度重[钙化体积HU850=(604.1±318.7) mm^3],平均瓣环周长大于平均瓣环上水平周长[(78.8±7.4) mm vs (67.1±6.7) mm,P<0.001],平均左心室流出道(LVOT)周长大于平均瓣环周长[(81.6±10.5) mm vs (78.8±7.4) mm,P=0.003]。置入瓣中瓣患者12例(24.5%),瓣膜置入过深患者14例(34.1%)。置入瓣中瓣患者比无瓣中瓣患者瓣环平均内经[(26.8±2.4) mm vs(23.9±2.0) mm,P<0.001]、周长[(85.7±7.0) mm vs (76.6±6.1) mm,P<0.001]及LVOT平均内径[(28.4±2.7) mm vs (24.3±3.1) mm,P<0.001]、周长[(91.3±9.1) mm vs (78.4±8.9) mm,P<0.001]更大,LVOT周长/瓣环上水平周长比值虽差异无统计学意义[(125.5±12.3)%vs (119.4±15.7)%,P=0.067],但趋近阈值。瓣膜置入过深患者比无置入过深患者LVOT周长/瓣环周长比值更大[(108.0±7.4)%vs (101.2±6.7)%,P=0.005]。结论:二叶式主动脉瓣患者的瓣环和LVOT平均内径及LVOT周长/瓣环周长比值对于TAVR中瓣中瓣的置入及瓣膜置入深度具有一定影响。
