Abstract
We herein present a clinical case of root and ascending aortic replacement in a patient with borderline enlargement of the ascending aorta and aortic valve insufficiency. A 65-year-old man was admitted to our clinic with signs of heart failure. Subsequent echocardiography and contrast-enhanced computed tomography revealed hemodynamically significant aortic insufficiency, as well as expansion of the ascending aorta. Diameter at the levels of the sinuses of Valsalva, sinotubular junction and tubular portion of the ascending aorta were 48, 47 and 44 mm, respectively. Based on the aforementioned data, indications for isolated aortic valve replacement were determined. Although the main portion of the surgery was unremarkable, at its final stage, a rupture of a section of the ascending aorta occurred. The results of intraoperative express histological examination of the enlarged aorta revealed connective tissue dysplasia and cystic median necrosis. Replacement of the ascending aorta was performed using the modified Bentall–De Bono technique. This case demonstrated that a borderline aortic dilatation of 40–50 mm at the ascending aorta was associated with pathological changes in its wall, which can cause fatal complications (rupture and dissection) and may require a more aggressive approach during surgical correction. Intraoperative express histological examination of the wall of the ascending aorta in ambiguous situations can help determine the scope of the intervention.Received 16 March 2021. Revised 14 September 2021. Accepted 15 September 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authors Literature review: S.Yu. Boldyrev, M.A. Marukyan Drafting the article: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova Critical revision of the article: S.Yu. Boldyrev, V.A. Porkhanov Surgical treatment: S.Yu. Boldyrev, M.A. Marukyan Final approval of the version to be published: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova, K.O. Barbukhatti, V.A. Porkhanov
Highlights
СЛУЧАИ ИЗ КЛИНИЧЕСКОЙ ПРАКТИКИЦитировать: Болдырев С.Ю., Марукян М.А., Суслова В.Н., Барбухатти К.О., Порханов В.А.
Операция Бенталла – де Боно при аортальной недостаточности и интраоперационном разрыве погранично расширенной восходящей аорты: клинический случай.
Представлен клинический случай протезирования корня и восходящего отдела аорты у пациента с пограничным расширением восходящей аорты и недостаточностью аортального клапана.
Summary
Цитировать: Болдырев С.Ю., Марукян М.А., Суслова В.Н., Барбухатти К.О., Порханов В.А. Операция Бенталла – де Боно при аортальной недостаточности и интраоперационном разрыве погранично расширенной восходящей аорты: клинический случай. Представлен клинический случай протезирования корня и восходящего отдела аорты у пациента с пограничным расширением восходящей аорты и недостаточностью аортального клапана. В литературе много противоречивой информации, согласно которой объем коррекции колеблется от пластики восходящей аорты до протезирования с сохранением или протезированием аортального клапана. Цель — демонстрация клинического случая протезирования корня и восходящего отдела аорты у пациента с пограничным (менее 50 мм) расширением восходящей аорты и тяжелой аортальной недостаточностью
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