New Aortic Root Remodeling Surgery in Aortic Root Aneurysm

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New Aortic Root Remodeling Surgery in Aortic Root Aneurysm Roland Hetzer, MD, PhD, Takeshi Komoda, MD, PhD, Satuski Komoda, MD, PhD, Felix Berger, MD, PhD, Michael Huebler, MD The Annals of Thoracic Surgery Volume 89, Issue 4, Pages 1260-1264 (April 2010) DOI: 10.1016/j.athoracsur.2009.12.036 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Fixation of the prosthetic ring to the aortic root with five previously placed mattress sutures. At the commissure between the right coronary sinus and the noncoronary sinus, the ring is fixed with a suture placed externally. (L = left coronary sinus; N = noncoronary sinus; R = right coronary sinus.) The Annals of Thoracic Surgery 2010 89, 1260-1264DOI: (10.1016/j.athoracsur.2009.12.036) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Plication of sinus of Valsalva. The noncoronary sinus of Valsalva is plicated after longitudinal incision. The right or left sinus of Valsalva (or both) are plicated longitudinally from outside when the sinus is dilated (as indicated in Table 1). (L = left coronary sinus; N = noncoronary sinus; R = right coronary sinus.) The Annals of Thoracic Surgery 2010 89, 1260-1264DOI: (10.1016/j.athoracsur.2009.12.036) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The aortic root is wrapped with a Valsalva vascular graft, which is anchored to the prosthetic ring. The distal end of the graft and the transected aortic wall are sutured together. The Annals of Thoracic Surgery 2010 89, 1260-1264DOI: (10.1016/j.athoracsur.2009.12.036) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Intraoperative photograph showing the completed remodeling of an aortic root in an 18-year-old girl in whom a straight vascular graft was used instead of a Valsalva vascular graft. The Annals of Thoracic Surgery 2010 89, 1260-1264DOI: (10.1016/j.athoracsur.2009.12.036) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Coronal magnetic resonance images of the heart in a patient (A) before remodeling of the aortic root and (B) at follow-up. The Annals of Thoracic Surgery 2010 89, 1260-1264DOI: (10.1016/j.athoracsur.2009.12.036) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 (A) Changes in the diameter of the aortic root at the level of the sinuses of Valsalva after surgery in each patient (one line corresponds to one patient). (B) Changes in the grade of aortic regurgitation after surgery in each patient (one line corresponds to one patient). The Annals of Thoracic Surgery 2010 89, 1260-1264DOI: (10.1016/j.athoracsur.2009.12.036) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions