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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 617-621, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TE David and CM Feindel
A number of patients who require an operation for complications of
annuloaortic ectasia, such as aortic incompetence or aneurysm of the aortic
root (or both), have normal aortic valve leaflets. We have treated these
patients by excising the aneurysmal portion of the ascending aorta and
sinuses of Valsalva but by leaving the aortic valve leaflets and some
arterial wall attached to the left ventricular outflow tract. The aortic
valve is reimplanted inside a collagen- impregnated tubular Dacron graft,
similar to what is done for implantation of an aortic valve homograft. The
coronary arteries are also reimplanted. This operation was performed in 10
patients. All patients had annuloaortic ectasia and five had the stigmata
of Marfan syndrome. Four patients had acute aortic dissection. There were
no operative deaths, but one patient required composite replacement of the
aortic valve and ascending aorta because of persistent aortic incompetence.
Postoperative Doppler echocardiography revealed normal aortic valve
function in six patients and mild incompetence in three. The preliminary
results of this new operation are encouraging. Further investigation is
necessary to establish the best size, shape, and type of material that
should be used to replace the aortic root while preserving the aortic
valve.
ARTICLES
An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta
Division of Cardiovascular Surgery, University of Toronto, Ontario, Canada.
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