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Διάταση, Ανεύρυσμα Αορτικής Ρίζας. Ποια η Χειρουργική Αντιμετώπιση. ΔΡΟΣΟΣ ΓΕΩΡΓΙΟΣ Διευθυντής Χειρουργικής Κλινικής Καρδιάς-Θώρακος και Αγγείων Γ.Ν. «Γ. Παπανικολάου» Θεσσαλονίκη. Aortic Root. Anatomic segment between LV and Asc Ao. Subcomissural triangles Aortic annulus Aortic cusps

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Διάταση, Ανεύρυσμα Αορτικής Ρίζας. Ποια η Χειρουργική Αντιμετώπιση

ΔΡΟΣΟΣ ΓΕΩΡΓΙΟΣ

Διευθυντής Χειρουργικής Κλινικής Καρδιάς-Θώρακος και Αγγείων

Γ.Ν. «Γ. Παπανικολάου» Θεσσαλονίκη


Aortic root
Aortic Root Ρίζας.

Anatomic segment between LV and Asc Ao

  • Subcomissural triangles

  • Aortic annulus

  • Aortic cusps

  • Sinuses of Valsalva

  • Sinotubular Junction


1 subcomissular triangles
1. Subcomissular triangles Ρίζας.

  • Important role in the function of the aortic valve


2 aortic annulus
2. Aortic annulus Ρίζας.

  • Fibrous structure

  • Fibrous continuity with the AMVL


3 aortic cusps
3. Aortic cusps Ρίζας.

  • 3 cusps

  • 3 sinuses



Well described technique of this operation aorta with reimplantation of the coronary arteries

Long term implication and results are related to the specifics of prosthetic aortic valve replacement


Bioprosthetic valves
Bioprosthetic valves aorta with reimplantation of the coronary arteries

  • Structural valve deterioration

  • Reoperative aortic root replacement

Mechanical valves

Thromboembolic and hemorrhagic complication


30% of patients who undergo aortic root replacement have a aorta with reimplantation of the coronary arteriesmorphologically normal aortic valve


In the past 15 years valve-preserving aortic root has evolved into an increasingly accepted alternative to composite of aorta and valve



Contraindications
Contraindications evolved into an increasingly accepted alternative to composite of aorta and valve

  • Calcification of aortic cusps

  • AAA which starts at the level of STJ

  • Patients>75y

  • Patients with connective tissue disease who have a large annulus>30mm


T david introduced the re implantation operation
T. David evolved into an increasingly accepted alternative to composite of aorta and valve introduced the “re-implantation” operation

  • Dacron graft is seated below the annulus of the aortic valve resulting in protection of both the valve leaflets and the annulus


Re implantation operation david v
Re-implantation operation “David V” evolved into an increasingly accepted alternative to composite of aorta and valve

  • More durable through the prevention of aortic insufficiency caused by either annular dilation or primary valve leaflet dysfunction


ΠΡΟΕΓΧΕΙΡΗΤΙΚΑ evolved into an increasingly accepted alternative to composite of aorta and valve


ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ evolved into an increasingly accepted alternative to composite of aorta and valve


David v
“David V” evolved into an increasingly accepted alternative to composite of aorta and valve

  • More suited for patients with connective tissue disorders

  • Two suture lines

  • Reoperation simply consist of removal of native valve

  • Young patients whose valve can not be spared


  • Attractive operations evolved into an increasingly accepted alternative to composite of aorta and valve

  • Excellent survival

  • Acceptable risk of reoperation and recurrent AI

  • Properly performed, recapitulates the anatomy of aortic root

  • No anticoagulation


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