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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

Anatomic segment between LV and Asc Ao

  • Subcomissural triangles

  • Aortic annulus

  • Aortic cusps

  • Sinuses of Valsalva

  • Sinotubular Junction


1. Subcomissular triangles

  • Important role in the function of the aortic valve


2. Aortic annulus

  • Fibrous structure

  • Fibrous continuity with the AMVL


3. Aortic cusps

  • 3 cusps

  • 3 sinuses


  • 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


Well described technique of this operation

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


Bioprosthetic valves

  • Structural valve deterioration

  • Reoperative aortic root replacement

Mechanical valves

Thromboembolic and hemorrhagic complication


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


  • 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

  • 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

  • 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”

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


ΠΡΟΕΓΧΕΙΡΗΤΙΚΑ


ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ


“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


  • 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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