Background Little information is available regarding the incidence of aortic dissection or rupture in patients with a dilated ascending aorta after aortic valve replacement (AVR). The present clinical study aimed to demonstrate the incidence of aortic complications after AVR in patients with a dilated ascending aorta and to clarify those risk factors associated with the progression of a dilated ascending aorta or late aortic events. Methods and Results A total of 35 patients with a dilated ascending aorta at the time of AVR were enrolled. A dilated ascending aorta was defined as 40 mm or greater in diameter by preoperative computed tomography or operative findings. The baseline ascending aorta diameter ranged from 40 to 55 mm with a mean of 44.8±4.4 mm. There was a high frequency of bicuspid valve disease in patients with a dilated ascending aorta (57%). The mean follow-up interval was 8.1±3.5 years (range: 2.3-13). Aortic events occurred in 5 patients (aortic dissection in 1, rupture in 2, reoperation in 2) during the follow-up. One aortic dissection developed at a baseline aortic size of 42 mm, whereas 2 aortic ruptures occurred at baseline aortic sizes of 47 mm and 50 mm. There was no statistically significant univariate association between any of the patient clinical characteristics and late aortic events or ascending aortic progression. Conclusion Although the clinical course of patients with a dilated ascending aorta is unpredictable, aortic events may occur even in patients with a baseline aortic diameter of <50 mm. Therefore, preventive aortic surgery at the time of AVR should be considered to prevent aortic dissection or rupture in patients with an even slightly dilated ascending aorta with a diameter of 40 to 50 mm, unless the patient has a high operative risk or older age. (Circ J 2005; 69: 392 -396)

We report the case of a 61-year-old man with prosthetic valve endocarditis after both aortic valve replacement and mitral annuloplasty. Necrotic tissue and dehiscence of the suture line in the aortic annulus were found, and the infection extended to the anterior portion of the mitral prosthetic ring. The autologous pericardial cord was used as a substitute for the infected mitral prosthetic ring, and aortic root replacement was performed with a stentless bioprosthesis. The autologous pericardial cord was useful as a substitute for an infected mitral prosthetic ring.

Stenotic lesion of the left coronary artery is an unnoticed but complicating feature of supravalvular aortic stenosis (SAS). We present successful repair of SAS with left coronary ostial stenosis. A 9-year-old girl was diagnosed as Williams syndrome associated with SAS. She had no symptoms of angina but cardiac catheterization revealed severe stenosis of the left coronary artery ostium. We adopted Brom's three patch technique, which could enlarge the aortic root and ostial lesion of left coronary artery inclusively. This method is also ideal regarding restoration of the aortic root geometry.

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