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small aortic root

Masood Abu-Halima, Mustafa Kahraman, Dominic Henn, Tanja Rädle-Hurst, Andreas Keller, Hashim Abdul-Khaliq, Eckart Meese
BACKGROUND: MicroRNAs (miRNAs) are small RNAs regulating gene expression post-transcriptionally. While acquired changes of miRNA and mRNA profiles in cancer have been extensively studied, little is known about expression changes of circulating miRNAs and messenger RNAs (mRNA) in monogenic constitutional anomalies affecting several organ systems, like Marfan syndrome (MFS). We performed integrated miRNA and mRNA expression profiling in blood samples of Marfan patients in order to investigate deregulated miRNA and mRNA networks in these patients which could serve as potential diagnostic and prognostic tools for MFS therapy...
March 12, 2018: Journal of Translational Medicine
Tarun Chakravarty, Justin Cox, Yigal Abramowitz, Sharjeel Israr, Abhimanyu Uberoi, Sunghan Yoon, Damini Dey, Paya Zadeh, Wen Cheng, Raj R Makkar
AIMS: Residual gradients >20mmHg after transcatheter valve-in-valve (ViV) are associated with worse survival. This study evaluated the feasibility of high-pressure post-dilation with a non-compliant balloon after transcatheter ViV in small surgical valves to optimize hemodynamics. METHODS AND RESULTS: Thirty patients underwent ViV implantation in surgical valves with internal dimension ≤ 19mm. High-pressure post-dilation to 16-20 atmospheres with a non-compliant balloon was performed in 12 patients and 18 patients underwent ViV without post-dilation...
February 27, 2018: EuroIntervention
Hiroshi Tanaka, Yutaka Okita
Annular fixation has an important role aortic valve repair for aortic regurgitation. We have used the reimplantation procedure as annular fixation combined with cusp repair rechniques for aortic valve repair even in small aortic root( <50 mm) since 2010. Freedom from aortic valve reoperation was 93% at 5 years and 79% at 8 years. Freedom from greater than moderate aortic regurgitation was 80% at 5 years and 71% at 8 years. Although the outcomes were not satisfactory and should be improved, this technique would be one of choices in selected patients, considering durability of bioprostheses and anticoagulation-related events in mechanical valves...
January 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Tetsuro Uchida, Azumi Hamasaki, Yoshinori Kuroda, Masahiro Mizumoto, Atsushi Yamashita, Jun Hayashi, Shuto Hirooka, Ai Ishizawa, Kentaro Akabane, Mitsuaki Sadahiro
BACKGROUND: The Bentall procedure is a reliable treatment of various types of aortic root pathology. Furthermore, the aortic valve-sparing aortic root replacement also has been accepted as an ideal procedure especially in young patients. Recently, we have developed a simple valve-sparing operation focused on standardization and reproducibility. METHODS: From 2011 to 2017, 44 consecutive patients underwent aortic root replacement( Bentall 17, David 27)in our institution...
January 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Jae Won Song, Woong Han Kim, Jae Gun Kwak, Ji Young Park
Patients with double-inlet left ventricle usually have a small ascending aorta. In the Norwood procedure, which involves a staged operation, a neoaorta is constructed with a homograft, and the pulmonary artery plays a role in the systemic circulation. Dilatation or aneurysmal changes can occur over time due to the exposure of the neoaorta to systemic pressure, which may induce adverse effects on adjacent structures. We report a rare case of surgical repair for neoaortic root dilataiton with aortic regurgitation, compressing the left pulmohary artery, in a patient who underwent the Norwood procedure...
February 2018: Korean Journal of Thoracic and Cardiovascular Surgery
Changtian Wang, Mario Lachat, Evelyn Regar, Ludwig Karl von Segesser, Francesco Maisano, Enrico Ferrari
OBJECTIVES: To treat aortic valve disease and concomitant root disease with transcatheter techniques, 'composite graft' implants are required. Our goal was to assess the suitability of the porcine aortic root for transcatheter root repair tests. METHODS: Eight pig hearts explanted from domestic pigs used in experimental surgery were compared to data from the literature on human hearts. The measured diameters included those of the annulus, sinuses of Valsalva, coronary ostia, sinotubular junction, ascending aorta, innominate artery and aortic arch...
February 2, 2018: Interactive Cardiovascular and Thoracic Surgery
Marco Pocar, Davide Passolunghi, Maria Clemencia Araujo Dos Anjos, Alessandro Mazzola
Coronary reimplantation is a key step of aortic root replacement and may present special challenges under specific circumstances. Particularly in reoperations, mobilization of the coronary ostia can be hazardous and reattachment may require one or more interposition grafts to avoid tension, as originally originally described by Cabrol. We report a modified reimplantation technique of the coronary arteries which allows the creation of wide neo-ostia with minimal prosthetic material in case of a small aortic root...
February 1, 2018: Annals of Thoracic Surgery
Stefan Klotz, Sina Stock, Hans-Hinrich Sievers, Michael Diwoky, Michael Petersen, Ulrich Stierle, Doreen Richardt
OBJECTIVE: Remodeling or reimplantation are established operative techniques of aortic valve-sparing root replacement. Long-term follow-up is necessary comparing tricuspid and bicuspid aortic valves. METHODS: A total of 315 patients (tricuspid, n = 225, bicuspid, n = 89, quadricuspid, n = 1; remodeling, n = 101, reimplantation, n = 214) were evaluated. Mean follow-up was 10.1 ± 5.6 and 6.4 ± 4.2 years for the remodeling and reimplantation group, respectively...
December 13, 2017: Journal of Thoracic and Cardiovascular Surgery
Manish Kumar, Santhanam Sridhar, Niranjan Thomas
BACKGROUND: Approximately 30% of babies born in India are low birth weight (LBW) and about 70% of LBW babies are small for gestational age (SGA). Though there are several trials that have evaluated cardiac function of intrauterine growth restricted (IUGR) babies in utero, there is limited data about postnatal cardiac function in SGA babies during early neonatal period. This study was conducted to evaluate the cardiac functions of SGA babies by serial echocardiographic measurements and compare this with appropriate for gestational age (AGA) babies during the early postnatal period...
January 16, 2018: Journal of Maternal-fetal & Neonatal Medicine
Gabriele Pesarini, Mattia Lunardi, Anna Piccoli, Leonardo Gottin, Daniele Prati, Valeria Ferrero, Roberto Scarsini, Aldo Milano, Alberto Forni, Giuseppe Faggian, Flavio Ribichini
Results of transcatheter aortic valve implantation (TAVI) for treatment of severe noncalcific isolated aortic regurgitation (AR) complicated by advanced heart failure or cardiogenic shock has been previously reported only in isolated case reports. Current self-expanding transcatheter aortic valves are designed to treat aortic valve stenosis, and have also been implanted in cases of severe AR due to degenerated bioprosthesis and in very few cases of native aortic valves. We report 13 consecutive inoperable patients with noncalcific, pure AR, and advanced heart failure treated with emergency percutaneous transfemoral implantation with self-expandable CoreValves at our institution between July 2012 and September 2017...
December 11, 2017: American Journal of Cardiology
Reza Tavakoli, Pichoy Danial, Ahmed Hamid Oudjana, Peiman Jamshidi, Max Gassmann, Pascal Leprince, Guillaume Lebreton
Controversy still surrounds the optimal biological valve substitute for aortic valve replacement. In light of the current literature, we review advantages and optimal indications of stentless compared to stented aortic bio-prostheses. Recent meta-analyses, prospective randomized controlled trials and retrospective studies comparing the most frequently used stentless and stented aortic bio-prostheses were analyzed. In the present review, the types and implantation techniques of the bio-prosthesis that are seldom taken into account by most studies and reviews were integrated in the interpretation of the relevant reports...
January 10, 2018: General Thoracic and Cardiovascular Surgery
Paul C Tang, Paul D DiMusto, Nilto C De Oliveira, Brooks L Rademacher, Jennifer L Philip, Shahab A Akhter, Charles W Acher
OBJECTIVE: This study investigated the growth and behavior of the ascending aorta in patients with descending thoracic aortic disease. METHODS: We examined 200 patients with descending thoracic aortic disease including acute type B dissection (n = 95), chronic type B dissection (n = 38), intramural hematoma (n = 23), and thoracoabdominal aortic aneurysms (n = 44). Images from computed tomography and magnetic resonance imaging were evaluated after three-dimensional reconstruction to examine the growth rate in those with >1 year of imaging follow-up (n = 108)...
December 21, 2017: Journal of Vascular Surgery
Mary Hunt Martin, Shabana Shahanavaz, Lynn F Peng, Jeremy D Asnes, Michelle Riley, William E Hellenbrand, David T Balzer, Robert G Gray, Doff B McElhinney
BACKGROUND: Since FDA approval of the Melody valve, transcatheter pulmonary valve replacement (TPVR) has been offered to an expanding population. Limited data exist regarding the safety and feasibility of TPVR in smaller patients. METHODS: All patients weighing <20 kg who underwent catheterization for percutaneous TPVR at four centers were reviewed. RESULTS: Of the 51 patients reviewed, 43 (84%) had successful valve implantation and 8 (16%) were found not to be candidates due to access veins too small (n = 3), coronary artery/aortic root compression (n = 3), and RVOT too large (n = 2)...
February 15, 2018: Catheterization and Cardiovascular Interventions
Thang Duc Vu, Min Zin Oo, Duc-Viet Nguyen, Ervin Marquez Ocampo, Yilin Ong, Suganya Cheyyatraivendran-Arularasu, Lian-Kah Ti, Mark A Richards, Theo Kofidis
OBJECTIVES: The transapical approach provides concurrent surgical access to the mitral and the aortic valves, the root of the aorta and the left atrium. We previously showed the feasibility of transapical cardioscopic (TAC) surgery in a non-survival porcine model. However, reproducibility and feasibility of ring implantation using TAC have not been reported. Therefore, in this study, we hypothesized that implantation of a mitral annuloplasty ring can be feasibly and safely carried out endoscopically via the apex of the heart...
August 30, 2017: Interactive Cardiovascular and Thoracic Surgery
Stoyan Kondov, Fabian Alexander Kari, Martin Czerny, Matthias Siepe
We present our surgical strategy in a patient with a bicuspid aortic valve Type I (R/N), aortic root aneurysm and papillary fibroelastoma on the aortic valve's cusp. He underwent valve-sparing aortic root replacement (David V Procedure); we also removed the papillary fibroelastoma from the fused right- and non-coronary cusp. In this case, we used a 34-mm straight Dacron graft for root replacement and an aortic annulus downsized to 30 mm. We use Hegar dilatators for the intraoperative measurement of the aortic annulus...
October 1, 2017: Interactive Cardiovascular and Thoracic Surgery
Matthew Cauldwell, Michael A Quail, Gillian S Smith, Ee Ling Heng, Sarah Ghonim, Anselm Uebing, Lorna Swan, Wei Li, Roshni R Patel, Dudley J Pennell, Philip J Steer, Mark R Johnson, Michael A Gatzoulis, Sonya V Babu-Narayan
BACKGROUND: The aim was to assess whether cardiovascular adaptation to pregnancy in women with repaired tetralogy of Fallot (TOF) adversely affects hemodynamic stability, in particular with respect to right ventricular (RV) dilatation, pulmonary regurgitation, or aortic root dilatation. METHODS AND RESULTS: This was a retrospective cohort study of women with repaired TOF with paired cardiovascular magnetic resonance scans before and after their first pregnancy (baseline RV end systolic volume index 49 mL/m(2) and RV end diastolic volume index 118 mL/m(2)) matched with a comparison group of nulliparous women with TOF...
July 23, 2017: Journal of the American Heart Association
Ghanim Khatib, Ahmet Baris Guzel, Umran Kucukgoz Gulec, Mehmet Ali Vardar
OBJECTIVE: Most of the ovarian cancers are diagnosed at advanced stages. As peritoneal carcinomatosis increases, especially when it extends to the diaphragm and intestinal mesos, probability of obtaining complete cytoreduction is reduced. Complete cytoreduction (residue zero: R0) is one of the main factors affecting survival [1-3]. Here we present a novel technique of stripping the peritoneal surfaces as a part of cytoreductive surgery in such cases. METHODS: A 55year-old woman diagnosed with peritoneal carcinomatosis was considered appropriate for primary cytoreduction after assessment of her thorax-abdominopelvic tomography, which revealed resectable intra-abdominal disease...
September 2017: Gynecologic Oncology
Marjolijn Renard, Laura Muiño-Mosquera, Elise C Manalo, Sara Tufa, Eric J Carlson, Douglas R Keene, Julie De Backer, Lynn Y Sakai
BACKGROUND: Sex-related differences as well as the adverse effect of pregnancy on aortic disease outcome are well-established phenomena in humans with Marfan syndrome (MFS). The underlying mechanisms of these observations are largely unknown. OBJECTIVES: In an initial (pilot) step we aimed to confirm the differences between male and female MFS patients as well as between females with and without previous pregnancy. We then sought to evaluate whether these findings are recapitulated in a pre-clinical model and performed in-depth cardiovascular phenotyping of mutant male and both nulliparous and multiparous female Marfan mice...
2017: PloS One
Fiona Doig, Rishen Naidoo, Vinod Sharma, Peter Tesar
BACKGROUND: We present the case of a 23-year-old male with ventriculo-aortic dehiscence and a retrosternal false aneurysm communicating to the left ventricular outflow tract (LVOT) and ascending aorta. His history included aortic valve replacement (AVR) and mitral valve (MV) repair remotely, followed by two further operations for endocarditis and aortic root abscess. METHODS: The risk associated with the redo surgery required detailed planning and innovative techniques to allow it to be performed safely...
June 1, 2017: Heart, Lung & Circulation
Sina Stock, Hans-Hinrich Sievers, Doreen Richardt, Michael Scharfschwerdt
OBJECTIVES: Small aortic annuli are challenging in aortic valve replacement. Prosthesis-patient mismatch, accompanied by high transvalvular gradients and small orifice area, is an often faced problem impairing postoperative outcome. The new TRIBIO bioprosthesis aims to enable enhanced haemodynamics, being increasingly important with decreasing annular size. This study compares ex vivo hydrodynamics of TRIBIO with 2 established bioprostheses in small annuli at different stroke volumes, simulating 'rest' and 'exercise', and evaluates haemodynamics of TRIBIO in a sheep model...
November 1, 2017: Interactive Cardiovascular and Thoracic Surgery
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