En bloc aortic root resection and Commando procedure for aortomitral bioprosthetic endocarditis

Early aortomitral bioprosthetic degeneration with acute endocarditis represents a surgical challenge because it requires thoughtful preoperative evaluation and anticipation of a complex and difficult reoperation. The aortomitral continuity and fibrous skeleton is often completely destroyed, and hence mandates a double valve replacement with recreation of a new aortomitral continuity, with a pericardial patch for instance. This technique was originally described by Tirone David, and was named Commando procedure by the Cleveland Clinic group.1 Approaching the aortic root in the setting of redo surgeries is a challenge in and of itself, and herein we describe our technique for en bloc aortic root resection, followed by a Commando procedure

A Unique Hybrid Tricuspid Aortic Valve.

No abstract availabl

Transaortic approach for combined aortotricuspid valve endocarditis.

Aortotricuspid valve infective endocarditis (IE) is rare, and surgical reports are limited to a few. The traditional approach is a combined transaortic and transatrial valve repair or replacement. In a recent study, 1-year mortality rates in native multivalve endocarditis were close to 30%, and there has been a recent shift in pathogens toward Staphylococcus. 1 Independent predictors of mortality were older age, Staphylococcus aureus, heart failure, septic shock, and persistent bacteremia. Herein, we report the management of a young patient with combined aortotricuspid valve endocarditis and our nontraditional, albeit successful, surgical approach

MAComa: Caseous calcifications presenting as intracardiac mass.

Caseous calcifications of the mitral annulus (CCMA) have been reported with a 2.7% prevalence in a necropsy-series. However, the exact frequency is unknown, and it is rare in our own clinical experience. An echocardiographic-study estimated the prevalence in the general population as 0.06%–0.07%. [...

Valve sparing root replacement: reimplantation of the aortic valve.

CLINICAL VIGNETTE : The first patient in the video is an asymptomatic 65-year-old male patient with permanent atrial fibrillation and permanent pacemaker for atrioventricular block of second degree. Transthoracic echocardiogram shows a tricuspid aortic valve (TAV) with eccentric aortic insufficiency (AI) grade 3+ towards the mitral valve indicating a right coronary leaflet prolapse. The left ventricular end diastolic (LVEDD) and end systolic (LVESD) diameter are 66 and 38 mm, respectively. The left ventricular ejection fraction (LVEF) is 72%. The ventriculoaortic junction (VAJ) diameter is 28 mm, the sinus of Valsalva is 45 mm, the sinotubular junction (STJ) is 40 mm and the ascending aorta is 42 mm. The second patient in the video is an asymptomatic 47-year-old male with no particular medical history. Transthoracic echocardiogram shows a bicuspid aortic valve (BAV) with right/left fusion, commissure orientation of 160° and eccentric AI grade 3+ towards the mitral valve indicating prolapse of the fused leaflet. The LVEDD and LVESD are 70 and 51 mm, respectively. The LVEF is 54%. The VAJ diameter is 30 mm, the sinus of Valsalva is 45 mm, the STJ is 36 mm and the ascending aorta is 40 mm

Techniques in trileaflet aortic valve repair

Surgical techniques for regurgitant aortic valve pathology have evolved significantly in the last 20 years as a result of deeper understanding of functional structure and physiopathology of the aortic valve and the development of a common anatomical and functional language among specialists. The introduction of the functional classification of aortic valve regurgitation facilitated the development of standard surgical approaches to treat this pathology. The principles of aortic valve repair include the restoration of normal anatomy and geometry of the functional aortic root with the aim to provide a long-term stabilisation of the aortic annulus. We report a review of our approach and surgical techniques to repair the aortic valve and aortic root based on our long experience in the field

A rare case of pseudo-quadricuspid aortic valve repair.

No abstract availabl

Quadricuspid aortic valve repair.

CLINICAL VIGNETTE : A 47-year-old man was referred to our department for severe and symptomatic aortic regurgitation. The patient complained of shortness of breath (NYHA II-III) over the previous couple of months. He also presented with arterial hypertension, dyslipidaemia and a history of smoking. Physical examination revealed a diastolic murmur in the aortic and mitral valve areas. A transoesophageal ultrasound scan showed normal left ventricular function and severe aortic regurgitation on a quadricuspid valve. Further, the left ventricle was slightly dilated with an end-diastolic diameter (LVEDD of 61 mm) but not aortic dilatation. A coronary angiogram did not show significant coronary lesions or anomalies. The patient was scheduled for elective repair of the aortic valve

Aortic annulus elevation for aortic valve and root replacement.

Aortic valve and root replacements require an in-depth understanding of the aortic root and annulus. Both structures can be asymmetric at times, and this needs to be recognized and taken into consideration when performing valve-sparing operations or other root-replacement procedures. Moreover, the geometry of the aortic annulus can be altered, and when performing an aortic root replacement this can distort the geometry of a neoaortic valve for instance, and lead to valve dysfunction, which is difficult to reverse. We are describing an altered aortic annulus, which required modification through annulus elevation before proceeding with aortic root replacement with a graft-reinforced pulmonary-autograft

Aortic root replacement with the reimplantation technique for recurrent root aneurysm, 24 years after root replacement with the remodeling technique in a Marfan patient.

Clinical vignette : A 36-year-old female with Marfan syndrome underwent aortic root replacement with the Yacoub (remodeling)-procedure for a root aneurysm at age 12. She returned 24 years later with recurrent severe aortic root dilation of 61 mm, and aortic annular enlargement of 35 mm, with moderate aortic regurgitation of her native aortic valve. Her left ventricular ejection fraction was mildly depressed at 45–50%. She also presented with moderate mitral regurgitation from an anterior mitral valve prolapse. [...