An Option for Concomitant Management of Moderate Marfan Root Aneurysm at the Time of Mitral Valve Repair: A Role for Personalized External Aortic Root.

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An Option for Concomitant Management of Moderate Marfan Root Aneurysm at the Time of Mitral Valve Repair: A Role for Personalized External Aortic Root Support Umberto Benedetto, PhD, Xu Yu Jin, FRCP, FRCS, Elaine Hill, FRCA, FFICM, Tom Treasure, MD, FRCS, Mario Petrou, PhD, FRCS The Annals of Thoracic Surgery Volume 102, Issue 6, Pages e499-e501 (December 2016) DOI: 10.1016/j.athoracsur.2016.05.031 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The essential features of personalized external aortic root support (PEARS). (A) Preoperative magnetic resonance imaging (MRI). (B) The mesh support on the thermoplastic model of the patient's aorta. (C) Depiction of mesh in position. (D) MRI in 2014, 10 years after PEARS placement. (BCA = brachiocephalic artery; LCA = left coronary artery; RCA = right coronary artery.) The Annals of Thoracic Surgery 2016 102, e499-e501DOI: (10.1016/j.athoracsur.2016.05.031) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Histology of the mesh–aorta composite. These histologic preparations are from the only patient to have died with a mesh in place, more than 4 years after operation for a presumed arrhythmia without dissection and with a competent aortic valve [3]. (A) The mesh fibers (yellow arrow) are completely incorporated with collagen fibers running through and around the porous mesh (left panel) and new adventitial blood vessels outside the mesh (green arrow). (B) The aortic media in the unsupported arch has the appearances of Marfan syndrome. (C) The cardiac pathologists reported the histologic appearances in the proximal aorta within the mesh support to be normal with apparent healing in the supported segment. The Annals of Thoracic Surgery 2016 102, e499-e501DOI: (10.1016/j.athoracsur.2016.05.031) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Transesophageal echo images of midesophageal four-chamber views (A) before and (B) after mitral valve repair in patient 2. (A) Doppler color-flow mapping demonstrated severe mitral valve regurgitation with jet directed anteriorly. Mitral regurgitation was fully corrected. (B) TOE images of the aortic valve in short axis views (C) before and (D) after personalized external aortic root support (PEARS) implantation in patient 1. (C) The Doppler color-flow mapping demonstrated mild central aortic regurgitation (AR). (D) AR was almost completely abolished after PEARS implantation. The Annals of Thoracic Surgery 2016 102, e499-e501DOI: (10.1016/j.athoracsur.2016.05.031) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions