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J Thorac Cardiovasc Surg 2009;138:1244-1246
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

A novel method for reconstructing the sinus and annulus for the treatment of annuloaortic ectasia

Takeshi Shimamoto, MDa,*, Akira Marui, MD, PhDa, Takeshi Nishina, MD, PhDa, Yoshiaki Saji, MDa, Masashi Komeda, MD, PhDa,b,c

a Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
b Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
c Department of Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato, Japan

Received for publication June 3, 2008; revisions received August 22, 2008; accepted for publication September 1, 2008.

* Address for reprints: Takeshi Shimamoto, MD, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara, Sakyo, Kyoto 606-8507, Japan. (Email: shimamo@kuhp.kyoto-u.ac.jp).

The first 20% of the full text of this article appears below.


   Introduction
 

Formula Video clip is available online.

 

The treatment of aortic root dilatation with a leaking valve requires a multimodal approach, including root reimplantation or remodeling with or without tailoring of the sinotubular junction and valvular apparatus.1,2Go However, valve-sparing procedures are time-consuming, technically demanding, and associated with intraoperative bleeding.

Here we report a novel reconstruction method for the treatment of annuloaortic ectasia with a leaking valve. In this method the dilated sinuses were excluded, and the annulus was effectively suspended by suturing a bovine pericardial patch inside the dilated aortic root.


   Clinical Summary
 
A 47-year-old man was referred to our hospital for the treatment of aortic regurgitation (AR) and aortic arch aneurysm; his cardiac status was New York Heart Association class III. The coronary angiographic findings were unremarkable. Transthoracic echocardiographic analysis revealed moderate-to-severe AR with dilatation of the right and noncoronary sinuses (Figure 1, A ; also see Video 1). The left ventricular (LV) end-diastolic diameter was 52 mm, and the LV ejection fraction was 54%. Computed tomographic analysis showed annuloaortic ectasia with disproportionately enlarged right and noncoronary sinuses and aneurysm of the ascending aorta and aortic arch. The diameters of the sinotubular junction, ascending aorta, and aortic arch were 42, 60, and 70 mm, respectively.


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  		Figure 1. Preoperative (A) and postoperative (B) echocardiograms in an apical long-axis view showing that preoperative severe aortic regurgitation (. . . [Full Text of this Article]

 





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