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Διάταση, Ανεύρυσμα Αορτικής Ρίζας. Ποια η Χειρουργική Αντιμετώπιση

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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  1. Διάταση, Ανεύρυσμα Αορτικής Ρίζας. Ποια η Χειρουργική Αντιμετώπιση ΔΡΟΣΟΣ ΓΕΩΡΓΙΟΣ Διευθυντής Χειρουργικής Κλινικής Καρδιάς-Θώρακος και Αγγείων Γ.Ν. «Γ. Παπανικολάου» Θεσσαλονίκη

  2. Aortic Root Anatomic segment between LV and Asc Ao • Subcomissural triangles • Aortic annulus • Aortic cusps • Sinuses of Valsalva • Sinotubular Junction

  3. 1. Subcomissular triangles • Important role in the function of the aortic valve

  4. 2. Aortic annulus • Fibrous structure • Fibrous continuity with the AMVL

  5. 3. Aortic cusps • 3 cusps • 3 sinuses

  6. 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

  7. Well described technique of this operation Long term implication and results are related to the specifics of prosthetic aortic valve replacement

  8. Bioprosthetic valves • Structural valve deterioration • Reoperative aortic root replacement Mechanical valves Thromboembolic and hemorrhagic complication

  9. 30% of patients who undergo aortic root replacement have a morphologically normal aortic valve

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

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

  12. 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

  13. 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

  14. Re-implantation operation “David V” • More durable through the prevention of aortic insufficiency caused by either annular dilation or primary valve leaflet dysfunction

  15. ΠΡΟΕΓΧΕΙΡΗΤΙΚΑ

  16. ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ

  17. “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

  18. 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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