A Case of Aortic Valve Remodeling Operation for Aortic Localized Dissection

(Department of Cardiovascular Surgery, Himi Municipal Hospital, Kanazawa Medical University, Himi, Japan)

Shigeru Sakamoto Jun Kiyosawa Hideaki Nishimoriz
A 39-year-old man was admitted to our hospital with symptoms of anterior chest pain and slightly dyspnea. At that time, he had chest discomfort, hypertension, and with enlargement of mediastinal shadow on chest X ray. Medical treatment rapidly improved the hypertension and the other symptoms. Transthoracic echocardiography(TTE)and enhanced chest CT revealed aortic root dilation, and trivial aortic valve regurgitation, but these examinations could not identify the cause of such as typical Stanford type A dissection. Transesophageal echocardiography(TEE)and chest MD-CT were undertaken on 7 days after the admission revealed a localized aortic dissection, intimal flap, and enlargement of sinotubular junction(STJ). An Urgent operation was performed. During the operation, a localized aortic dissection appeared to be above the left coronary cusp through the right coronary cusp of the aortic valve, but the valve findings were normal, so we decided to perform a aortic valve remodeling operation. The aortic sinuses were excised leaving 4mm of arterial wall attached to the aortic annulus and around the coronary arteries. A Woven Dacron graft of diameter equal to the diameter of the STJ was tailored to recreate three aortic sinuses. The three commissures were suspended into the tailored graft and the neo-aortic sinuses were sutured to the aortic annulus and remnants of arterial wall. The coronary arteries were reimplanted into their respective neo-aortic sinuses and the graft anastomosed to the distal aorta. The postoperative course was uneventful. We concluded that this procedure is useful for a localized aortic dissection around the coronary orifice. 
  Jpn. J. Cardiovasc. Surg. 42:200-203(2013)

Keywords:aortic valve remodeling operation, aortic localized dissection, intimal flap, MD-CT