• Journal of Chest Surgery
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• 제45권4호
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• pp.205-212
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• 2012

Aortic valve sparing operations were developed to preserve the native aortic valve during surgery for aortic root aneurysm as well as surgery for ascending aortic aneurysms with associated aortic insufficiency. There are basically two types of aortic valve sparing oprations: remodeling of the aortic root and reimplantation of the aortic valve. These operations have been performed for over two decades and the clinical outcomes have been excellent in experienced hands. Although remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, long-term follow-up suggests that the latter is associated with lower risk of developing aortic insufficiency. Failure of remodeling of the aortic root is often due to dilatation of the aortic annulus. Thus, this type of aortic valve sparing should be reserved for older patients with ascending aortic aneurysm and normal aortic annulus whereas reimplantation of the aortic valve is more appropriate for young patients with inherited disorders that cause aortic root aneurysms. This article summarizes the published experience with these two operations. They are no longer experimental procedures and should be part of the surgical armamentarium to treat patients with aortic root aneurysm and ascending aortic aneurysms with associated aortic insufficiency.

• Journal of Chest Surgery
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• 제49권6호
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• pp.489-492
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• 2016

The original valve-sparing procedures for aortic root aneurysms were remodeling and reimplantation of the aortic root. The remodeling technique provides more physiologic movement of the cusps within 3 reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles. However, the durability of remodeling has been a matter of concern due to the high rate of aortic insufficiency when annular dilation is not addressed. Therefore, a modified approach was developed, combining a physiologic remodeling of the root with a subvalvular annuloplasty. This case report highlights the first case of successful aortic root remodeling with external subvalvular ring annuloplasty in Korea.

• Journal of Chest Surgery
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• 제28권7호
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• pp.704-707
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• 1995

The use of the patient`s pulmonary valve for replacement of the patient`s diseased aortic valve was introduced and developed by Mr. Donald Ross. The long term benefits of having a normal, fully viable, trileaflet semilunar valve in aortic position was demonstrated. A 38 year old male had histories of failures of previously implanted aortic prosthetic valves twice and evidence of progressive heart failure. At operation, aortic root abscess was found; the abscess extension to adjacent structures and partial valve dehiscence had occurred. The patient underwent replacement of the aortic root with autologous pulmonary valve, autologous pericardial patch repair of left ventricuar outflow tract and recontruction of the right ventricular outflow tract and pulmonary artery with prosthetic valved conduit. Postoperatively, the patient recovered well. Postoperative doppler echocardiography demonstrated minimal central regurgitation in new aortic valve. Aortic root replacement with pulmonary autograft in a patient of recurrent aortic root abscess and false aneurysm of left ventricuar outflow tract was experienced and reported with follow up echocardiography.

• Journal of Chest Surgery
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• 제34권7호
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• pp.557-558
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• 2001

순턴향대학 턴안병원 흥부외과에서는 Stan$\ulcorner$old type A급성 대동맥 박리증, 대동맥 근부 동맥류 및 대동맥 폐쇄부전을 보인 45세 말판 증후군 환자에게 24m Hemashield 도관을 이용하여 Yacoub-David 수술법에 의한 대동맥 근부 개형술(aortic root remodeling procedure)을 시행하였다 수술은 환자의 대동맥 판막을 보존하면서 대동맥등을 포함한 대동맥 근부의 질병조직을 모두 제거한 후, 글이 발살바동 모양으로 3등분된 인조혈관으로 대동맥등으로부터 상행 대동맥가지 대치하는 방법으로 하였다. 환자는 수술 후 양호한 회복을 보였고 대 동맥 판막의 역류는 완전히 교정되었다.

• 한국임상수의학회지
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• 제17권1호
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• pp.187-193
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• 2000

Fifteen adult Korea Jin-do dogs were studied by echocardiography to obtain the basic data of the imaging planes and normal references ranges to the aorta and pulmonary artery internal dimension. Measurements of aortic root internal dimension(AOID) and right pulmonary artery internal dimension (RPAID) were made at modified pulmonary arteries level short-axis view and left ventricular outflow tract long-axis view. The aortic root internal dimension and right pulmonary artery internal dimension at modified pulmonary arteries level short-axis view were 18.7$\pm$1.3mm (mean$\pm$SD) and 10.1$\pm$0.8mm, respectively. And RPAID/AOID was 0.5$\pm$0.1mm. The aortic root internal dimension and right pulmonary artery internal dimension at left ventricular outflow tract long-axis view were 19.3$\pm$1.6 mm and 10.7$\pm$1.3mm, respectively. And RPAID/AOID was 0.5$\pm$0.1mm. These results indicate that modified pulmonary arteries level short-axis view is useful planes to examine the aortic root and pulmonary arteries, and aortic root internal dimension is significantly higher(40~50%)than the right pulmonary artery internal dimension. Therefore measurements of aortic root internal and right pulmonary artery internal dimension can be used for monitoring dilation of pulmonary artery.

• Journal of Chest Surgery
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• 제45권3호
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• pp.141-147
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• 2012

Background: Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. Materials and Methods: A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. Results: The mean follow-up duration was $4.9{\pm}3.1$ years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of $4.4{\pm}2.5$ years of echocardiographic follow-up (p<0.001). Conclusion: Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures.

• Journal of Chest Surgery
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• 제55권5호
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• pp.413-416
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• 2022

A 32-year-old woman diagnosed with Turner syndrome presented to the hospital for an evaluation of cardiovascular complications. Preoperative computed tomography (CT) and echocardiography showed progression of aortic root and ascending aorta dilatation, as well as a bicuspid aortic valve. There was no evidence of aortic regurgitation. We planned valve-sparing aortic root replacement and ascending aorta replacement with a high risk of aortic rupture. Intraoperatively, we incidentally found a juxtacommissural origin of the right coronary artery (RCA). We performed aortic valve reimplantation using a graft designed with a key-shaped hole to wrap the juxtacommissural-origin RCA by modifying the Florida sleeve technique. Coronary blood flow was patent on postoperative CT angiography, and there was no evidence of aortic regurgitation on postoperative echocardiography. The patient was discharged from the hospital on postoperative day 7 without any complications.

• Journal of Chest Surgery
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• 제48권5호
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• pp.359-363
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• 2015

The comprehensive aortic root and valve reconstruction (CARVAR) technique comprises two main procedures, which are aortic root reduction using prosthetic rings and neo-leaflet reconstruction using a pericardial patch. Although concerns about durability of the pericardial neo-leaflet have been raised in the CARVAR technique, complications related to leaflet reconstruction have not been reported to date. The present report describes two cases of complications associated with leaflet reconstruction. After resecting the reconstructed leaflets, aortic valve replacement was performed in the patients. Careful and close follow-up is required for patients who had undergone CARVAR surgery, and aortic valve surgery should be performed in a timely manner if needed.

• Journal of Chest Surgery
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• 제48권4호
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• pp.272-276
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• 2015

Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder that is characterized by aggressive arterial and aortic disease, often involving the formation of aortic aneurysms. We describe the cases of two children with LDS who were diagnosed with aortic root aneurysms and successfully treated by valve-sparing aortic root replacement (VSRR) with a Valsalva graft. VSRR is a safe and suitable operation for children that avoids prosthetic valve replacement.

• Journal of Chest Surgery
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• 제46권5호
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• pp.353-356
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• 2013

A 74-year-old man was diagnosed with aortic root aneurysm and two-vessel coronary disease. Echocardiographic assessment revealed an enlarged sinus of Valsalva 60 mm in diameter with mild aortic regurgitation. Florida sleeve repair was performed using a vascular graft combined with coronary artery bypass grafting. The postoperative course was uncomplicated and follow-up echocardiographic evaluations showed an aortic root diameter of 38 mm without aortic insufficiency up to 1 year after surgery.