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ORIGINAL ARTICLE
Year : 1999  |  Volume : 1  |  Issue : 5  |  Page : 163-169

Conservative treatment of dilated ascending aorta a new technique


Department of Cardiovascular Surgery, V. Monaldi Hospital, Seconda Università degli Studi di Napoli, Naples -, italy

Correspondence Address:
Attilio Renzulli
Via Aquila 144 80143 Naples
italy
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Source of Support: None, Conflict of Interest: None


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Background The treatment of dilatation of the ascending aorta associated with aortic valve disease is still controversial. Replacement of ascending aorta and aortic valve with a composite conduit may be too radical an approach, especially in patients with moderate dilatation. To repair a dilated ascending aorta with associated aortic valve disease, we devised a technique of aortoplasty. Methods and Results Between July 1996 and July 1998, 12 patients underwent aortic valve replacement and ascending aortoplasty. Seven of them had aortic regurgitation, 3 aortic stenosis, 1 postendocarditic periprosthetic leak, and 1 calcified bioprosthesis. Indications for aortoplasty were: echocardiographic aortic diameter between 5 and 6 cm and macroscopic appearance of normal aortic wall. Contraindications to aortoplasty were: Marfan's disease, bicuspid aortic valve, calcification of ascending aortic wall, aortic dissection, and fusiform aneurysm without aortic valve disease.The aortic valve was replaced with a bileaflet valve and the ascending aorta was repaired with “waistcoat” technique. All patients survived the operation and no early or late complication was observed. Postoperative echocardiographic study showed a significant reduction of both sinotubular and ascending aortic diameters. Late postoperative echocardiographic study did not show any significant further change in the aortic diameters. Conclusion Plastic reconstruction of dilated ascending aorta with reduction of its diameter and aortic valve replacement can reduce wall stress and the incidence of late aneurysm formation or aortic dissection. Further experience and a longer follow-up time are necessary to establish the effectiveness of the technique.


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