Paul P. Urbanski, MD, PhD, Vadim Irimie, MD, Lukas Lehmkuhl, MD, PhD

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Presentation transcript:

Aortic repair in Marfan syndrome: Let's not forget the arch when talking about the root Paul P. Urbanski, MD, PhD, Vadim Irimie, MD, Lukas Lehmkuhl, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 156, Issue 1, Pages 38-39.e3 (July 2018) DOI: 10.1016/j.jtcvs.2018.03.046 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Preoperative and postoperative 3-dimensional volume rendering technique reconstructions of contrast-enhanced computed tomography scans (computed tomography angiography) of 52-year-old woman with confirmed diagnosis of Marfan syndrome who received patient-tailored aortic root repair with replacement of noncoronary and right coronary (marked with arrowhead) sinus, leaving the left coronary sinus (marked with arrow) untouched. A total arch replacement was performed concomitantly because the patient presented with dissection history of abdominal aorta and positive familial history. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 38-39.e3DOI: (10.1016/j.jtcvs.2018.03.046) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Three-dimensional volume rendering technique reconstruction (left) and multiplanar reconstruction (right) of contrast-enhanced computed tomography scans (computed tomography angiography) of 42-year-old man with confirmed diagnosis of Marfan syndrome demonstrating acute aortic dissection (dissection membrane is marked with arrowheads). He underwent root replacement with mechanical valve conduit elsewhere at age of 25 years; however, the distal anastomosis between conduit and aorta was performed below the ostium of the right coronary artery (marked with green arrow), which, apparently, originated relatively high. The dotted line indicates border between conduit and native ascending aorta. The aortic wall around this ostium is calcified. AA, Aortic arch; A, native ascending aorta; AC, aortic conduit. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 38-39.e3DOI: (10.1016/j.jtcvs.2018.03.046) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Postoperative 3-dimensional volume rendering technique reconstruction (left) and multiplanar reconstruction (right) of computed tomography angiography of the same patient after limited replacement (performed elsewhere) of the ascending aorta (proximal and distal anastomoses are marked with white arrows) leaving the dissected aortic arch (with dissected arch branches) and the aortic wall around right coronary artery (marked with green arrow) ostium untouched. Dissection membrane in the aortic arch is marked with arrowheads. The dotted lines indicate borders between particular anatomic parts. AA, Aortic arch; AP, aortic prosthesis; A, native ascending aorta; AC, aortic conduit; IA, innominate artery. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 38-39.e3DOI: (10.1016/j.jtcvs.2018.03.046) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Postoperative 3-dimensional volume rendering technique reconstruction (left) and multiplanar reconstruction (right) of computed tomography angiography of the same patient after complete ascending aorta and aortic arch replacement performed in our center 7 months after ascending aorta surgery (demonstrated in Figure E2). The distal anastomosis is marked with white arrow. The entire aortic arch (including dissected origins of arch branches), all remaining native ascending aorta wall (including calcified origin of right coronary artery), and the entire ascending aorta prosthesis were resected, and the arch prosthesis was anastomosed to the valve conduit. The right coronary artery (marked with green arrow) was implanted to the graft using saphenous vein interposition and the dissection membrane (marked with arrowheads) was resected in proximal part of descending aorta. AP, Aortic prosthesis; IA, innominate artery. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 38-39.e3DOI: (10.1016/j.jtcvs.2018.03.046) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2018 156, 38-39 The Journal of Thoracic and Cardiovascular Surgery 2018 156, 38-39.e3DOI: (10.1016/j.jtcvs.2018.03.046) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions