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small aortic root

Matthew Valdis, Gaetano DeRose, Linrui Guo, Michael W A Chu
Young patients with bicuspid aortic valve disease and aortopathy remain a clinical challenge, with many requiring multiple corrective operations throughout their lifetimes. Innovative surgical approaches are often required to address complex aortic pathologic conditions but leave patients at risk for reintervention, lifelong anticoagulation, and suboptimal hemodynamics. We describe an active 44-year-old female triathlete with recurrent bicuspid aortic stenosis, a small aortic root, a hypoplastic aortic arch and complex distal arch, and a descending aortic aneurysm, who underwent a single-stage reconstruction with a combined Ross procedure, hybrid arch, and frozen elephant trunk reconstruction...
December 2016: Canadian Journal of Cardiology
Ravi K Ghanta, Irving L Kron
Patient prosthesis mismatch (PPM) can occur when a prosthetic aortic valve has an effective orifice area (EOA) less than that of a native valve. A recent study by Zorn and colleagues evaluated the incidence and significance of PPM in high risk patients with severe aortic stenosis who were randomized to transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). TAVR is associated with decreased incidence of severe PPM compared to traditional SAVR valves. Severe PPM increases risk for death at 1 year postoperatively in high risk patients...
October 2016: Journal of Thoracic Disease
K Daskalakis, A Karakatsanis, P Stålberg, O Norlén, P Hellman
BACKGROUND: In patients with small intestinal neuroendocrine tumours (SI-NETs), serotonin and other cytokines released from tumour cells may induce fibrosis, leading to carcinoid heart disease and abdominal fibrotic reactions. The aim of this study was to assess the prevalence, clinical complications and management of this reaction in the abdomen. METHODS: This was a retrospective cohort study of patients with SI-NETs diagnosed between 1985 and 2015. Clinical data, outcomes, radiological findings, and surgical and radiological interventions were reviewed...
November 10, 2016: British Journal of Surgery
Mohamed Marzouk, Ganesh Shanmugam, Dimitri Kalavrouziotis, Siamak Mohammadi
Aortic valve replacement with a Perceval sutureless bioprosthesis is a viable rescue option for a failed aortic stentless prosthesis. However, a dilated sinotubular junction and ascending aorta are reported as a contraindication for this technique. We describe an aortic sutureless valve implantation in a patient with a dilated ascending aorta and small aortic root after Dacron graft replacement of the ascending aorta in a failed aortic stentless bioprosthesis.
December 2016: Annals of Thoracic Surgery
Michinobu Nagao, Yuzo Yamasaki, Takeshi Kamitani, Satoshi Kawanami, Masatoshi Kondo, Hiromichi Sonoda, Taisuke Fujioka, Hiroshi Honda
The purpose of this study is to analyze the geometrical characteristics of aortic root and left ventricular (LV) function in aortic stenosis (AS) using 256-slice coronary-computed tomography angiography (CCTA). Retrospective ECG-gated 256-slice CCTA data from 32 patients with tricuspid AS scheduled for aortic valve replacement, and 11 controls were analyzed. Aortic root geometry was measured using multiplanar reconstruction CT images. CCTA data set was transformed into 100 phases/cycle using motion coherence image processing...
October 13, 2016: Heart and Vessels
Sven Maier, Fabian Kari, Bartosz Rylski, Matthias Siepe, Christoph Benk, Friedhelm Beyersdorf
Open aortic arch replacement is a complex and challenging procedure, especially in post dissection aneurysms and in redo procedures after previous surgery of the ascending aorta or aortic root. We report our experience with the simultaneous selective perfusion of heart, brain, and remaining body to ensure optimal perfusion and to minimize perfusion-related risks during these procedures. We used a specially configured heart-lung machine with a centrifugal pump as arterial pump and an additional roller pump for the selective cerebral perfusion...
September 2016: Journal of Extra-corporeal Technology
Aly Ghoneim, Ismail Bouhout, Philippe Demers, Amine Mazine, Mary Francispillai, Ismail El-Hamamsy, Michel Carrier, Yoan Lamarche, Denis Bouchard
OBJECTIVE: Aortic valve replacement (AVR) in patients with a small aortic annulus is a challenging problem. The objective of this study was to compare 4 surgical approaches in terms of hemodynamics and perioperative outcomes. METHODS: A retrospective single-center study included 351 consecutive patients with a small aortic annulus (≤21 mm) who underwent aortic valve surgery between January 2007 and December 2014. Surgical techniques included standard AVR in 259 (74%) patients, aortic root enlargement in 20 (6%), implantation of a stentless bioprosthesis in 23 (6%), and sutureless AVR in 49 (13%)...
October 2016: Journal of Thoracic and Cardiovascular Surgery
Hossein Mohammadi, Raymond Cartier, Rosaire Mongrain
The diseases of the coronary arteries and the aortic root are still the leading causes of mortality and morbidity worldwide. In this study, a 3D global fluid-structure interaction of the aortic root with inclusion of anatomically inspired small coronary arteries using the finite element method is presented. This innovative model allows to study the impact and interaction of root biomechanics on coronary hemodynamics and brings a new understanding to small coronary vessels hemodynamics. For the first time, the velocity profiles and shear stresses are reported in distal coronary arteries as a result of the aortic flow conditions in a global fluid-structure interaction model...
September 3, 2016: International Journal for Numerical Methods in Biomedical Engineering
Peter Chiu, D Craig Miller
Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement...
July 2016: Annals of Cardiothoracic Surgery
Giordano Tasca, Riccardo Vismara, Andrea Mangini, Claudia Romagnoni, Monica Contino, Alberto Redaelli, Gianfranco Beniamino Fiore, Carlo Antona
BACKGROUND: Aortic valve replacement has evolved recently with the development of the sutureless bioprosthesis. One such valve is the Perceval bioprosthesis, which is built by mounting leaflets of bovine pericardium to a thin stent; this approach has the potential to provide an excellent fluid dynamic performance. We undertook an in vitro study to compare the hydrodynamic performance of the sutureless bioprosthesis with two standard pericardial stented bioprostheses (Crown and Magna)...
August 17, 2016: Annals of Thoracic Surgery
Edda Bahlmann, Dana Cramariuc, Jan Minners, Mai Tone Lønnebakken, Simon Ray, Christa Gohlke-Baerwolf, Christoph A Nienaber, Nikolaus Jander, Reinhard Seifert, John B Chambers, Karl Heinz Kuck, Eva Gerdts
AIMS: In aortic valve stenosis (AS), having a small aortic root may influence both the assessment of AS severity and the treatment strategy. The aim was to test the prognostic implications of having a small aortic root in AS within a large prospective study. METHODS AND RESULTS: We used data from 4.3-year follow-up of 1560 patients with asymptomatic, initially mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study. A small aortic root was defined as inner aortic sinotubular junction diameter indexed for body height <1...
August 3, 2016: European Heart Journal Cardiovascular Imaging
Anne Marie Jelsig
Hamartomatous polyps (HPs) in the gastrointestinal (GI) tract are rare compared to other types of GI polyps, yet they are the most common type of polyp in children. The symptoms are usually rectal bleeding, abdominal pain, obstipation, anaemia, and/or small bowel obstruction. The polyps are typically removed concurrently with endoscopy when located in the colon, rectum, or stomach, whereas polyps in the small bowel are removed during push-enteroscopy, device-assisted enteroscopy, or by surgery. HPs can be classified as juvenile polyps or Peutz-Jeghers polyps based on their histopathological appearance...
August 2016: Danish Medical Journal
Yuzhou Gui, Sheng Yao, Hong Yan, Liang Hu, Chengyin Yu, Fei Gao, Cong Xi, Huihui Li, Yang Ye, Yiping Wang
AIMS: Atherosclerosis is the most common cause of cardiovascular diseases, such as myocardial infarction and stroke. We hypothesized that nagilactone B (NLB), a small molecule extracted from the root bark of Podocarpus nagi (Podocarpaceae), suppresses atherosclerosis in an atherosclerotic mouse model. METHODS AND RESULTS: Male apoE-deficient mice on C57BL/6J background received NLB (10 and 30 mg/kg) for 12 weeks. Compared with the model group, NLB treatment (10 and 30 mg/kg) significantly reduced en face lesions of total aorta areas...
October 2016: Cardiovascular Research
Thekla H Oechtering, Carl F Hons, Malte Sieren, Peter Hunold, Anja Hennemuth, Markus Huellebrand, Johann Drexl, Michael Scharfschwerdt, Doreen Richardt, Hans-Hinrich Sievers, Jörg Barkhausen, Alex Frydrychowicz
OBJECTIVE: The anatomically shaped sinus prosthesis (Uni-Graft W SINUS; Braun, Melsungen, Germany) used in valve-sparing aortic root replacement promises physiological hemodynamics believed to grant physiologic valve function. Using time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI), we analyzed sinus vortex formation and transvalvular pressure gradients in patients with sinus prosthesis compared with age-matched and young healthy volunteers. METHODS: Twelve patients with sinus prosthesis (55 ± 15 years), 12 age-matched and 6 young healthy volunteers (55 ± 6 years, 25 ± 3 years, respectively) were examined at 3T with a 4D flow magnetic resonance imaging sequence...
August 2016: Journal of Thoracic and Cardiovascular Surgery
Marco M Ciccone, Francesca Cortese, Michele Gesualdo, Antonio DI Mauro, Silvio Tafuri, Giuseppina Mancini, Lucia Angrisani, Pietro Scicchitano, Nicola Laforgia
BACKGROUND: Cardiovascular and renal disease are nowadays among the leading cause of morbidity and mortality in Western Countries. Low birth weight has been recently considered a key factor in determining cardiovascular disease and long term renal disease in adulthood. METHODS: In our study we analyzed, through echocardiography, eco color Doppler of carotid arteries, ultrasound of abdominal aorta and kidneys, morphological characteristics of cardiovascular and renal system, in a in a group of children born preterm with very low birth weight, (birth weight<1500 grams) and in a group of children, age and sex matched, born at term with weight appropriate for gestational age...
June 29, 2016: Minerva Pediatrica
S Ram Kumar, Neeraj Bansal, Winfield J Wells, Vaughn A Starnes
BACKGROUND: After a Ross procedure, a small subset of patients requires reintervention for autograft dilatation or valve insufficiency. We sought to determine the indications, nature, and outcomes of autograft reinterventions in the left ventricular outflow tract after a Ross procedure. METHODS: We retrospectively reviewed the charts of 316 consecutive patients, age 4 days to 70 years, who underwent a Ross procedure at our institution. Of these, 47 patients (15%) required autograft reintervention during a median follow-up of 8...
June 24, 2016: Annals of Thoracic Surgery
Hideki Oshima, Tomonobu Abe, Yuji Narita, Akihiko Usui
A 72-year old man with an unruptured aneurysm of the right sinus of Valsalva and aortic insufficiency underwent aortic root replacement using a valved composite graft created with a 28-mm woven Dacron graft (Gelweave Valsalva™ graft, Vascutek Terumo, Renfrewshire, Scotland) and a 25-mm stented bioprosthetic aortic valve (Carpentier-Edwards PERIMOUNT pericardial bioprosthesis, Edwards Lifesciences, Irvine, CA, USA). His postoperative course was uneventful. He had undergone a follow-up CT scan once a year. Although no abnormal signs were detected 5 years after surgery, a CT scan performed in the sixth postoperative year revealed an aortic false aneurysm around the Dacron graft...
October 2016: Interactive Cardiovascular and Thoracic Surgery
Y F Li, Y F Li, Z F Xie, X Zhang, S S Wang, Z W Zhang
OBJECTIVE: To evaluate the feasibility of applying AMPLATZER Vascular Plug Ⅱ (AVP Ⅱ) in transcatheter closure of congenital coronary artery fistula in children. METHOD: Transcatheter closure procedure applying AVP Ⅱ was carried out in 7 patients (3 males and 4 females, age 1.2-12.0 years) with congenital coronary artery fistula between May 2014 and September 2015 in Pediatric Cardiology Department of Guangdong Cardiovascular Institute. Selective coronary artery angiography and aortic root angiography were performed after the release of the device to evaluate the immediate therapeutic effect...
June 2, 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Zhejun Cai, Ye Ding, Miao Zhang, Qiulun Lu, Shengnan Wu, Huaiping Zhu, Ping Song, Ming-Hui Zou
RATIONALE: Atherosclerotic calcification is highly linked with plaque rapture. How calcification is regulated is poorly characterized. OBJECTIVE: We sought to determine the contributions of AMP-activated protein kinase (AMPK) in atherosclerotic calcification. METHODS AND RESULTS: Aortic calcification was evaluated in aortic roots and brachiocephalic arteries of atherosclerotic prone ApoE(-/-) mice or in mice with dual deficiencies of ApoE and AMPKα isoforms in whole body (ApoE(-/-)/AMPKα1(-/-) and ApoE(-/-)/AMPKα2(-/-)) or vascular smooth muscle cell (VSMC)-specific or macrophage-specific knockout of AMPKα1 fed with Western diet for 24 weeks...
July 22, 2016: Circulation Research
Jun Zhang, Yani Liu, Ligang Liu, Youbin Deng
UNLABELLED: SummaryWe present quite a rare case of extracardiac unruptured right sinus of valsalva aneurysm (SVA) complicated with atherothrombosis in a young adult man. A 35-year-old male with a giant unruptured SVA arising from the right coronary sinus (RCS) with extracardiac protrusion was diagnosed by echocardiography. Contrast-enhanced computed tomography (CT) revealed a huge calcified aneurysm with mural thrombi originating from the aortic root, and about 80% stenosis at the initial segment of the right coronary artery (RCA)...
March 2016: Echo Research and Practice
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