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Aortoplasty
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Douglas M. Behrendt – One of the best experts on this subject based on the ideXlab platform.
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Supravalvular Aortic Stenosis: A Modification of Extended Aortoplasty
The Annals of thoracic surgery, 1998Co-Authors: John B. Steinberg, Ralph E Delius, Douglas M. BehrendtAbstract:A modification of the Doty extended Aortoplasty for supravalvular aortic stenosis has been recently adopted. This modification, which entails placement of an additional patch in the left coronary sinus, results in a more symmetric aortic root. This technique has been applied with success to 3 patients.
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long term follow up of extended Aortoplasty for supravalvular aortic stenosis
The Journal of Thoracic and Cardiovascular Surgery, 1995Co-Authors: Ralph E Delius, John B. Steinberg, Thomas J Lecuyer, Donald B Doty, Douglas M. BehrendtAbstract:Abstract Extended Aortoplasty is an operation that was designed to provide a symmetric reconstruction of the aortic root in patients with supravalvular aortic stenosis. The aim of this report is to provide long-term follow-up of the original cohort of 15 patients who underwent extended Aortoplasty between 1975 and 1983. Follow-up was obtained in 14 patients. One patient was lost to follow-up 3 years after operation; he was included in this report. An echocardiogram, chest radiograph, and electrocardiogram were obtained for each surviving patient. The median length of follow-up was 141 months (range 36 to 238). The median preoperative gradient was 90 mm Hg (range 55 to 150). The median immediate postoperative gradient was 20 mm Hg (range 0 to 50, p p p = not significant compared with immediate postoperative gradient). Two patients died: one of left ventricular failure after a subsequent aortic valve replacement and one of chronic left ventricular failure. The Kaplan-Meier estimate of survival at 218 months for all patients was 77.4% (70% confidence limits 62% to 93%). The estimated freedom from reoperation for all patients was 69% at 218 months (70% confidence limits 56% to 82%). Univariate analysis revealed that the presence of a bicuspid valve is a significant risk factor for reoperation ( p = 0.038), but not for death ( p = 0.51). The Kaplan-Meier estimate of freedom from reoperation for patients with a bicuspid aortic valve was 42.9% at 141 months (70% confidence limits 21% to 65%). Extended Aortoplasty provides effective long-term relief of the pressure gradient across the supravalvular ridge. However, a significant number of patients require subsequent operations, particularly those with a bicuspid aortic valve. (J Thorac Cardiovasc Surg 1995;109:155-63)
Neelam Desai – One of the best experts on this subject based on the ideXlab platform.
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Supravalvar aortic stenosis: 19 years of surgical experience
Indian Journal of Thoracic and Cardiovascular Surgery, 2015Co-Authors: Trushar Gajjar, Neelam DesaiAbstract:Objective Supravalvar aortic stenosis (SVAS) is an uncommon congenital cardiac anomaly characterized by varying degrees of left ventricular outflow tract obstruction distal to the aortic valve. We would like to share our experience with this condition over a period of 19 years. Methods Between April 1994 and June 2013, 22 consecutive patients of supravalvar aortic stenosis underwent surgical correction at our institute. There were 16 males and 6 females. Age ranged from 3 to 38 years. William’s syndrome was present in seven patients. Out of 22 cases 19 were of a localized type and 3 were diffuse in nature. The mean peak gradient was 110.4 mmHg (range 72–140 mmHg). Of the 19 patients with localized type of stenosis, 17 were successfully treated with single patch Aortoplasty while two patients were treated with extended Aortoplasty. The patients with diffuse type required extended Aortoplasty with extensive endarterectomy. Three patients in all had coronary ostial involvement that required additional intervention. Results Twenty patients were discharged in stable condition while two patients died in the immediate postoperative period. Four patients developed neurological events including the two early deaths. The remaining 18 patients were asymptomatic. Postoperative echocardiogram obtained for all patients before discharge showed average peak gradient of 21 mmHg (range 0–50 mmHg). Follow up was done at 3 months, 1, 3, 5, and 10 years. All patients were in NYHA class I, their average peak gradient was 23 mmHg, and there was no late mortality. Conclusion Our study demonstrates that standard patch Aortoplasty provides good postoperative results. We recommend use of a large patch, extending from the valve hinge in the sinus of Valsalva to the ascending aorta well above the obstructive waist. Coronary ostial involvement requires individualized treatment. Good surgical outcome can be achieved with an appropriate method of treatment in patients with both the forms of supravalvar aortic stenosis.
Jean-noël Fabiani – One of the best experts on this subject based on the ideXlab platform.
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Upper limb ischemia after subclavian flap Aortoplasty: unusual long-term complication.
The Annals of thoracic surgery, 2000Co-Authors: Frank F. Diemont, Eric S. Chemla, Pierre Julia, Didier Sirieix, Jean-noël FabianiAbstract:Repair of isolated coarctation of the aorta by subclavian flap Aortoplasty carries the disadvantage of impaired blood supply to the left arm. However, ligation of branches of the subclavian artery can be tolerated without manifest ischemia of the upper extremity. We report the case of a young man who suffered from left upper extremity ischemia 18 years after initial operation. Treatment consisted of carotid-subclavian bypass with good outcome. The surgical approach of coarctation by subclavian Aortoplasty should be reserved for specific cases, and if this procedure is performed, ligation of branches of the subclavian artery should be minimized to increase inflow into the left brachial artery.