Approach to the dilated aortic root

Boyer, John K; Gutiérrez, Fernando R.; Braverman, Alan C.

doi:10.1097/01.hco.0000139724.27066.e4

Cited by 29 publications

(17 citation statements)

References 88 publications

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“…Data to support this theory include the fact that: 1) patients with BAV have a larger ascending aortic diameter compared with age-matched subjects, irrespective of altered valvar hemodynamics; and 2) in patients with a normally functioning BAV, ascending aortic dilation is seen as early as infancy, and the rate of ascending aortic growth is greater than that of matched control subjects (29). Identified risk factors for aortic dissection in this patient group include: greater aortic stiffness (24), male sex (7), hypertension (30,31), aortic size (32,33), Turner syndrome (32), family history of aortic disease (31), and prior coarctation repair (7).…”

Section: Functional Aortic Impairment In Patients With Aortopathymentioning

confidence: 96%

The Dilated Aorta in Patients With Congenital Cardiac Defects

Yetman

Graham

2009

Journal of the American College of Cardiology

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Section: Functional Aortic Impairment In Patients With Aortopathymentioning

confidence: 96%

The Dilated Aorta in Patients With Congenital Cardiac Defects

Yetman

Graham

2009

Journal of the American College of Cardiology

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“…Although dissection is more common in patients with dilated aortas, there are reports of dissection in normal-sized aortic roots and after valve replacement (91). Risk factors for dissection have included aortic size (92,93), aortic stiffness (94), male sex (95), family history (96), and the presence of other lesions such as coarctation of the aorta (95) or Turner syndrome (97).…”

Section: Aortopathy and Aortic Dissectionmentioning

confidence: 98%

Bicuspid Aortic Valve Disease

Siu

Silversides

2010

Journal of the American College of Cardiology

861

603

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Bicuspid aortic valve (BAV) disease is the most common congenital cardiac defect. While the BAV can be found in isolation, it is often associated with other congenital cardiac lesions. The most frequent associated finding is dilation of the proximal ascending aorta secondary to abnormalities of the aortic media. Changes in the aortic media are present independent of whether the valve is functionally normal, stenotic, or incompetent. Although symptoms often manifest in adulthood, there is a wide spectrum of presentations ranging from severe disease detected in utero to asymptomatic disease in old age. Complications can include aortic valve stenosis or incompetence, endocarditis, aortic aneurysm formation, and aortic dissection. Despite the potential complications, 2 large contemporary series have demonstrated that life expectancy in adults with BAV disease is not shortened when compared with the general population. Because BAV is a disease of both the valve and the aorta, surgical decision making is more complicated, and many undergoing aortic valve replacement will also need aortic root surgery. With or without surgery, patients with BAV require continued surveillance. Recent studies have improved our understanding of the genetics, the pathobiology, and the clinical course of the disease, but questions are still unanswered. In the future, medical treatment strategies and timing of interventions will likely be refined. This review summarizes our current understanding of the pathology, genetics, and clinical aspects of BAV disease with a focus on BAV disease in adulthood.

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“…Despite numerous advances over the last 35 years, aneurysms and dissections of the ascending aorta remain a major challenge for cardiac surgeons [8]. Many pathological conditions that involve dilatation of the aorta with aortic regurgitation require replacement of the aortic valve and ascending aorta, either separately or as aortic root replacement with re-implantation of the coronary ostia into the graft.…”

Section: Discussionmentioning

confidence: 99%

Aortic root replacement in young adults: disease characteristics and early outcome

Meherwal

Collison

Gupta

et al. 2011

Indian J Thorac Cardiovasc Surg

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Introduction Aortic pathology requiring replacement of the aortic root is rare in young adults and maybe a group prone to atypical presentation and poorer outcomes. Here, we have studied the clinical features, pathological extent of aortic root disease and outcome of young adults undergoing aortic root replacement at this institution between 1995 and 2005. Patients and methods Retrospective study of the patients who underwent aortic root replacement at this institution between 1995 and 2005 between the ages of 18 and 40 (n= 53). Preoperative, intra-operative and postoperative data were collected on a standardized proforma. Results There were 48 males (90.5%) and five females (9.5%). Mean age was 32.3±0.7 years. 44% of patients had a preoperative diagnosis of either bicuspid or rheumatic aortic valve disease; 46 (87%) presented with chest pain and in 34 patients (64%) an aortic regurgitant murmur was audible. Most patients had aorto-annular ectasia, with 17 (32%) with aortic dissection. The dissecting flap arose at or near the sinotubular junction in 88% and terminated in the ascending aorta in 60%. 45 patients (84.9%) received modified Bentall's procedure; the rest underwent separate aortic valve and supra coronary aortic replacement. In hospital mortality was 1.8%. Follow up was 96% at mean follow up of 8.56 years after surgery.Conclusion Aortic surgery may be performed in young adults with good results. The disease characteristics of aortic dissection in this age group are favorable. The use of the Bentall procedure or separate aortic valve and supra coronary ascending aortic replacement offers good early and late clinical outcomes.

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Approach to the dilated aortic root

Abstract: Because there is often uncertainty regarding the dilated aortic root, this review will summarize the approach to diagnosis, evaluation, and management of aortic root aneurysms. Clinical features, diagnostic approaches, screening of relatives, and long term follow-up will be highlighted.

Cited by 29 publications

References 88 publications

The Dilated Aorta in Patients With Congenital Cardiac Defects

The Dilated Aorta in Patients With Congenital Cardiac Defects

Bicuspid Aortic Valve Disease

Aortic root replacement in young adults: disease characteristics and early outcome

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