China
Africa
Explore chapters and articles related to this topic
Complications of Septal Myectomy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Lawrence M. Wei, Charlotte Spear, Vinay Badhwar
Aortic insufficiency may be created inadvertently by unhinging the right coronary cusp. Unhinging occurs when the margin of resection strays too close to the aortic annulus, leaving the right coronary cusp with inadequate support. Prolapse of the cusp occurs and produces aortic insufficiency. This complication can be eliminated by beginning the resection no closer than 5 mm to the aortic annulus. Aortic insufficiency caused by this mechanism may occur late after surgery. An insufficiently unhinged valve may be repaired with a sub-annular annuloplasty ring or may require replacement.
Special Situations
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
If the aortic valve is replaced, the patient will be at risk for systemic thromboembolization for the duration of LVAD support. Most of the blood passes from the left side of the heart through the LVAD. As the aortic valve rarely opens, thrombus will form on a valve prosthesis even if the patient is fully anticoagulated. This is true regardless of whether a bioprosthesis or mechanical valve is employed. Thrombus that occurs on the valve can be ejected if the native heart contracts. The ideal solution to this clinical problem is unknown. Attempts to obliterate the left ventricular outflow tract by sewing the native aortic valve leaflets together at the time of LVAD insertion have been unsuccessful. The “repair” usually disrupts during the period of LVAD support. The most reasonable management approach for the patient with severe aortic insufficiency is to remove the native aortic valve and replace it with a bioprosthesis. Prior to implantation the bioprosthesis is modified by sewing an occlusive pericardial patch (Periguard pericardium, 4 × 4 cm; Bio-Vascular, Inc., Saint Paul, MN) over the left ventricular side of the valve (Fig. 7.2). The left ventricular outflow tract is thereby obliterated with a relatively nonthrombogenic well supported “valve prosthesis”. Thrombus may still form on the aortic side of the prosthesis, thus long-term anticoagulation is appropriate. If the LVAD were to suddenly fail the native ventricle can still eject through the LVAD itself provided left ventricular apex cannulation was employed.
Reiter’s syndrome
Published in Shiv Shanker Pareek, The Pictorial Atlas of Common Genito-Urinary Medicine, 2018
Long-term untreated Reiter’s syndrome may result in the following complications: aortic insufficiency (also referred to as aortic regurgitation) – the aortic valve of the heart fails to close properly, causing blood from the aorta to flow back into the left ventricle.cardiac arrhythmia – abnormal rhythm of the heart causing less efficient pumping.uveitis – inflammation of the middle layer of the eye comprising the iris, ciliary body and choroid.
Decision making in anomalous aortic origin of a coronary artery
Published in Expert Review of Cardiovascular Therapy, 2023
Hitesh Agrawal, Alexandra Lamari-Fisher, Keren Hasbani, Stephanie Philip, Charles D. Fraser, Carlos M. Mery
Several authors recommend taking down and resuspending the intercoronary commissure of the aortic valve to perform the unroofing in patients where the intramural segment travels below the level of insertion of the aortic valve [57]. We do not advocate manipulation of the aortic valve given the risk of development of aortic insufficiency as a result of such an intervention. A large retrospective study by the Congenital Heart Surgeons Society [58] recently reported the results of surgical intervention in 365 patients with AAOCA. Of all patients that underwent unroofings, 26% had some type of aortic valve commissural manipulation. New aortic insufficiency was present in 8% of patients after surgical intervention, and commissural manipulation was associated with the development of aortic insufficiency.
Progress in surgical interventions for aortic root aneurysms and dissections
Published in Expert Review of Cardiovascular Therapy, 2022
Shamini Parameswaran, Bulat A. Ziganshin, Mohammad Zafar, John A. Elefteriades
Aalaei-Andabili and colleagues investigated the short- and long-term outcomes of the Florida sleeve procedure and found that no patient had severe aortic insufficiency at 30 days. Furthermore, only 3 out of 140 patients had moderate aortic insufficiency at 30 days. Left ventricular function did not change during follow-up, and improvement in LVEDD was noticeable from baseline to 30 days, midterm and even at 5 years. This is comparable to a study of the David procedure where significant initial improvement of LVEDD was seen initially at 30 days; however, the LV diameter was found to be increased again by the end of the 5-year period. Furthermore, Aalaei-Andabili’s investigation found a 97% survival rate at 5 years and 93% survival at 8 years with the Florida sleeve procedure [47]. The Florida sleeve offers another very viable technical option, promising favorable results, when the surgeon is reluctant to pursue a full-scale root-sparing or root replacement operation.
Aortic Valve Neocuspidization (Ozaki technique) for Pediatric Patients: An Early Single Center Experience
Published in Structural Heart, 2020
David Blitzer, Damien Lapar, Daniel Montana, Anne Ferris, David Solowiejczyk, Lindsay Freud, Thomas Starc, Michael Snyder, Emile Bacha, David Kalfa
Results: There were 11 patients included (male=7). Median age at surgery was 15.8 years (Range 11.0-21.5). Aortic lesions were aortic insufficiency (AI) in 6 patients, aortic stenosis (AS) in 4 and mixed lesions in 1. Three patients had a previous balloon aortic valvuloplasty and one had a prior arterial switch operation for transposition of the great arteries. All three leaflets were replaced in all cases. Glutaraldehyde-treated autologous pericardium or a decellularized bovine pericardial patch was used in 8 and 3 patients respectively. At discharge, one patient had a mild to moderate AI and none had AS. There was no early and late mortality. Median follow-up was 1.1 years (range 0.2-1.4 years). One patient developed a dehiscence of a Photofix© patch 6 weeks after surgery, then underwent a redo AVNeo and has no AI or AS 1.2 years after reoperation. There was no other reoperation. At last follow-up, no patients had AS greater than mild and none had AI greater than mild.