Early Prognosis of Reduction Ascending Aortoplasty

Abstract

Congratulations to Liu and colleagues [1] for this valuable effort. We want to point out some issues about their study. As a basic principle of physics it is obvious that turbulent blood flow will appear after aortic valve replacement because of the inflexible stent of the prosthetic valve (rigid structures do not change diameter). The pathogenesis of aortic aneurysm includes degeneration and rupture of the myofibrils of the vascular wall. According to Laplace's law, the larger the vessel radius is, the greater the required wall tension will be to withstand a given internal fluid pressure. Therefore, these patients are followed with measurements of their aortic diameters. In Table 1 of the paper by Liu and colleagues [1], the numbers of patients with ascending aorta diameters larger than 5 cm are significantly different between the groups with and without bicuspid aortic valves. This issue may create a standardization problem when performing anterior resection of the ascending aorta because myofibrils may be disrupted at the posterior wall, but the intact anterior aortic wall may be resected with anterior resection. Another problem with this study could be the absence of information on the size and brand names of the prosthetic valves. These factors may have an effect on follow-up of aortic dilation. If aortic diameter is a measurement, indexing with the patient's height or body surface area may give more accurate results.

Reply

“…In addition, already formed TNF-a may be removed from the environment by hemofiltration. In the study by Mehaffey and colleagues [1], the mortality rate in the methylene blue group was higher, as shown in…”

“…We appreciate Dr Yurekli and colleagues' [1] interest in and considerate comments on our published article [2]. As they pointed out, more patients with a preoperative diameter of ascending aorta larger than 5 cm were found in the bicuspid aortic valve (BAV) group than in the non-BAV group.…”

“…Congratulations to Mehaffey and colleagues [1] for their effort. Tumor necrosis factor-a (TNF-a) produces negative inotropic and vasodilatory effects by acting on b receptors.…”

“…Therefore, these patients are followed with measurements of their aortic diameters. In Table 1 of the paper by Liu and colleagues [1], the numbers of patients with ascending aorta diameters larger than 5 cm are significantly different between the groups with and without bicuspid aortic valves. This issue may create a standardization problem when performing anterior resection of the ascending aorta because myofibrils may be disrupted at the posterior wall, but the intact anterior aortic wall may be resected with anterior resection.…”

“…Congratulations to Liu and colleagues [1] for this valuable effort. We want to point out some issues about their study.…”