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Διάταση, Ανεύρυσμα Αορτικής Ρίζας. Ποια η Χειρουργική Αντιμετώπιση PowerPoint PPT Presentation


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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

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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

Anatomic segment between LV and Asc Ao

  • Subcomissural triangles

  • Aortic annulus

  • Aortic cusps

  • Sinuses of Valsalva

  • Sinotubular Junction


1 subcomissular triangles

1. Subcomissular triangles

  • Important role in the function of the aortic valve


2 aortic annulus

2. Aortic annulus

  • Fibrous structure

  • Fibrous continuity with the AMVL


3 aortic cusps

3. Aortic cusps

  • 3 cusps

  • 3 sinuses


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  • Composite replacement of the aortic valve and ascending aorta with reimplantation of the coronary arterieshas been the standard operation for patients with aortic root aneurysm with or without aortic insufficiency


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Well described technique of this operation

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


Bioprosthetic valves

Bioprosthetic valves

  • Structural valve deterioration

  • Reoperative aortic root replacement

Mechanical valves

Thromboembolic and hemorrhagic complication


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30% of patients who undergo aortic root replacement have a morphologically normal aortic valve


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


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  • Remodeling of the root was originally designed by M. Yacoub and it has been demonstrated to restore root geometry and improve aortic valve competence


Contraindications

Contraindications

  • 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 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”

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


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ΠΡΟΕΓΧΕΙΡΗΤΙΚΑ


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ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ


David v

“David V”

  • 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


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  • Attractive operations

  • Excellent survival

  • Acceptable risk of reoperation and recurrent AI

  • Properly performed, recapitulates the anatomy of aortic root

  • No anticoagulation


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