A Case of Aortitis Syndrome with Annuloaortic Ectasia and Aortic Regurgitation Which Was Successfully Treated by Aortic Root Replacement with Freestyle Stentless Bioprosthesis.

Abstract

A 34-year-old woman who was suffering from aortitis syndrome with annuloaortic ectasia (AAE) and severe aortic regurgitation (AR) from 18 years of age was admitted for an aortic root replacement. She has been on 5 mg predonine daily. Aortography, CT and echocardiography examinations revealed dilated aortic annulus (D = 30 mm) and valsalva sinuses (D = 43 mm) and overstretched aortic valve leaflets. The ascending aorta was aneurysmal (D=50mm). Because of the patient's strong desire to have children, a Freestyle bioprosthesis was chosen for replacement. A collagen impregnated tube graft was interposed between the Freestyle and the proximal end of the transverse aorta. In order to reconstruct the coronary arteries, the Cabrol technique was utilized because of severe inflammatory adhesion of the aortic root. The patient had an uneventful postoperative course. This case shows that an aortic root replacement with Freestyle bioprosthesis offers a great benefit to those patients who are not suitable to receive postoperative anti-coagulation therapy to enable future pregnancy and child delivery. Jpn. J.

Annuloaortic Ectasia and Arteritis: Clinical Features, Treatments of Choice, and Causative Relations

“…In 20 patients, the degree of aortic valve regurgitation was unspecified. In the remaining 24 patients: it was severe in 12 (50%) [7,17,19,27,30,31,33,35,37] , moderate or severe in eight (33.3%) [16] , moderate in two (8.3%) [21,29] , mild in one (4.2%) [15] , and trace in one (4.2%) patient [18] .…”

“…The morphology of aortic valve leaflets was mentioned in six (13.3%) patients: three were normal [27] and three were abnormal (very thin [19] in one, thinned out with lax cusps [29] in one, and overstretch aortic valve leaflets in one patient [37] ).…”

“…Dilation of the sinuses of Valsalva was noted in 20 (35.1%) patients [7,14-17,20,37] , with a dimension of 52.8±11.2 (range, 35-70; median, 50.5) mm (n=12).…”

“…The timing of occurrence of AAE was reported in only two (4.4%) patients, at two and five years after the diagnosis of GCA was made [27] . The dimensions of aortic annulus were described in 22 (38.6%) patients, measuring 31.5±12.2 (range, 23-60; median, 26) mm (n=15) [7,14-19,34,37] .…”

“…The morphology of the coronary artery was described in 13 (22.8%) patients: it was normal in seven (53.8%) [7,26,27,29,37] and stenotic/occluded/ectatic in six (46.2%) patients [18,19,21,25,32] . Of the seven patients with normal coronary artery system, three had TA [7,26,37] and four had GCA [27,29] , and all six patients with diseased coronary artery system had TA [18,19,21,25,32] .…”