Aortic Valve Replacement Surgery Research Articles

SERRATUS ANTERIOR PLANE BLOCK FOR TOTALLY ENDOSCOPIC AORTIC VALVE REPLACEMENT SURGERY: A RANDOMIZED CONTROLLED TRIAL

<h3>Objective</h3> Totally endoscopic aortic valve replacement (AVR) has several benefits compared to the classic approach via sternotomy. However, pain after this thoracoscopic intervention is still a problem. The current pain treatment after AVR consists of opioids. Unfortunately, opioids have various side effects, such as nausea, constipation and respiratory depression. These side effects prevent a fast recovery after surgery. Therefore, it is essential to keep postoperative opioid consumption to a minimum. This study aims to investigate the efficacy of the serratus anterior plane (SAP) block in reducing acute postoperative pain after totally endoscopic AVR surgery. During a SAP block, local anaesthetics are injected in the plane beneath the anterior serratus muscle and in the plane between latissimus dorsi and serratus anterior in an ultrasound guided manner. This induces analgesia in dermatomes T2 to T9, which includes the place where surgical incision is realized. In this study, postoperative pain was compared between a treatment with the postoperative SAP block and a treatment without the SAP block. <h3>Design and method</h3> This double-blinded, mono-center, prospective, randomized controlled superiority trial took place in the Jessa Hospital in Hasselt, Belgium. Patients undergoing totally endoscopic AVR were included and randomly allocated to the experimental group, receiving the standard of care plus SAP block, or the control group, receiving normal standard of care. The primary outcome was total opioid (piritramide) consumption during the first 24h after surgery. Secondary outcome measures were physical and mental health measured by the SF-36 questionnaire on postoperative day 2 and length of stay in the ICU and hospital. <h3>Results</h3> Between December 3, 2020 and May 11, 2022, 67 patients were included, of which 62 were analysed. The need for opioid consumption was lower in the experimental group compared to the control group (12 mg [8-26] vs. 19 mg [13.5-30.5], p=0.06). Physical (p=0.70) and mental health (p=0.93) on postoperative day 2 and length of stay in the ICU (p=0.79) and hospital (p=0.84) were similar in both groups. <h3>Conclusions</h3> These preliminary data show a tendency towards reduced opioid consumption when postoperative single-shot serratus anterior plane block is added to routine postoperative care management after thoracoscopic AVR.

An endogenous inhibitor of angiogenesis downregulated by hypoxia in human aortic valve stenosis promotes disease pathogenesis

Aortic valve stenosis is the most common valve disease in the western world. Central to the pathogenesis of this disease is the growth of new blood vessels (angiogenesis) within the aortic valve allowing infiltration of immune cells and development of intra-valve inflammation. Identifying the cellular mediators involved in this angiogenesis is important as this may reveal new therapeutic targets which could ultimately prevent the progression of aortic valve stenosis. Aortic valves from patients undergoing surgery for aortic valve replacement or dilation of the aortic arch were examined both ex vivo and in vitro. We now demonstrate that the anti-angiogenic protein, soluble fms-like tyrosine kinase 1 (sFlt1), a non-signalling soluble receptor for vascular endothelial growth factor, is constitutively expressed in non-diseased valves. sFlt-1 expression was, however, significantly reduced in aortic valve tissue from patients with aortic valve stenosis while protein markers of hypoxia were simultaneously increased. Exposure of primary-cultured valve interstitial cells to hypoxia resulted in a decrease in the expression of sFlt-1. We further reveal using a bioassay that siRNA knock-down of sFlt1 in valve interstitial cells directly results in a pro-angiogenic environment. Finally, incubation of aortic valves with sphingosine 1-phosphate, a bioactive lipid-mediator, increased sFlt-1 expression and inhibited angiogenesis within valve tissue. In conclusion, this study demonstrates that sFlt1 expression is directly correlated with angiogenesis in aortic valves and the observed decrease in sFlt-1 expression in aortic valve stenosis could increase valve inflammation, promoting disease progression. This could be a viable therapeutic target in treating this disease.

Successful concomitant minimally invasive surgery for aortic valve stenosis and right lung cancer via right mini-thoracotomy : A case report

BackgroundThe case of aortic valve stenosis complicated with lung cancer have compelled cardiovascular surgeons to make challenging. We report the first successful short-term outcomes of one-stage minimally invasive aortic valve replacement and video-assisted thoracoscopic surgery lobectomy through right mini-thoracotomy in a patient with synchronous bicuspid severe aortic valve stenosis which was unsuitable for transcatheter aortic valve implantation and right lung cancer.Case presentationA 76-year-old man with severe aortic valve stenosis was diagnosed with lung cancer of the right upper lobe with stage IA2. Considering the potential risk of tumor metastasis, a one-stage surgical therapy for right lung cancer and type 0 bicuspid aortic valve stenosis was required; however, transcatheter aortic valve implantation was unsuitable due to a bicuspid aortic valve with severe calcification. Therefore, concomitant minimally invasive aortic valve replacement and lobectomy via right mini-thoracotomy were performed. The postoperative course was uneventful.ConclusionConcomitant aortic valve replacement and right lobectomy via right mini-thoracotomy may reduce surgical invasiveness, leading to early recovery. This surgical strategy is a useful option, particularly for patients with aortic valve stenosis complicated with right lung cancer.

AUSTRIAN SYNDROME IN A VACCINATED PATIENT: THE RARE STREPTOCOCCAL PNEUMONIAE TRIAD

AUSTRIAN SYNDROME IN A VACCINATED PATIENT: THE RARE STREPTOCOCCAL PNEUMONIAE TRIAD

CASE REPORT: BIOPROSTHETIC VALVE ENDOCARDITIS CAUSING NON-ST-ELEVATION MYOCARDIAL INFARCTION

CASE REPORT: BIOPROSTHETIC VALVE ENDOCARDITIS CAUSING NON-ST-ELEVATION MYOCARDIAL INFARCTION

Immediate and Late Complications in Aortic Valve Replacement Surgery

Abstract Congenital aortic bicuspid valve can evolve rapidly and at an early age to a severe aortic disease with significant stenosis and regurgitation. Therefore, cardiovascular surgery with mechanical aortic prosthesis implant is the only therapeutic solution. Despite a successful surgical procedure, complications can be numerous, especially post-operatively, as conduction disorders and arrhythmias. Also, given the recent guidelines recommendations to maintain the INR values above 2,5, chronic oral anticoagulation is critical in the long-term prevention of cardioembolic events. Thus, we are presenting the case of a patient diagnosed with a severe aortic disease secondary to a bicuspid aortic valve, who underwent a Bentall surgical procedure, later suffering a wide spectrum of complications, both immediate and late, especially due to long-term subtherapeutic INR values. The particularities of the case reside both in the multitude of complications that occurred in a particular chronological order and in the interfering mechanisms with the anticoagulant therapy.

Permanent pacemaker implantation after valve and arrhythmia surgery in patients with preoperative atrial fibrillation.

Among patients referred for cardiac surgery, atrial fibrillation (AF) is a common comorbidity and a risk factor for postoperative arrhythmias (eg, sinus node dysfunction, atrioventricular heart block), including those requiring permanent pacemaker (PPM) implantation. The purpose of this study was to evaluate the prevalence and long-term survival of postoperative PPM implantation in patients with preoperative AF who underwent valve surgery with or without concomitant procedures. Presented analysis pertains to the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. During the study period, 11,949 patients underwent valvular (aortic, mitral, or tricuspid valve replacement or repair) surgery and/or surgical ablation (SA) and were stratified according to postoperative PPM status. PPM implantation after surgery was necessary in 2.5% of patients, with significant variation depending on the type of surgery (from 1.1% in mitral valve repair to 3.3% in combined mitral and tricuspid valve surgery). In a multivariate logistic regression model, tricuspid intervention (P <.001), cardiopulmonary bypass time (P = .024), and endocarditis (P = .014) were shown to be risk factors for PPM. Over long-term follow-up, PPM was not associated with increased mortality compared to no PPM (hazard ratio 0.96; 95% confidence interval 0.77-1.19; P = .679). SA was not associated with PPM implantation. However, SA improved survival regardless of PPM status (log rank P <.001). In patients with preoperative AF, the need for PPM implantation after valve surgery or SA is not an infrequent outcome, with SA not affecting its prevalence but actually improving long-term survival.

Causal determinants of postoperative length of stay in cardiac surgery using causal graphical learning

ObjectiveWe aimed to learn the causal determinants of postoperative length of stay in cardiac surgery patients undergoing isolated coronary artery bypass grafting or aortic valve replacement surgery. MethodsFor patients undergoing isolated coronary artery bypass grafting or isolated aortic valve replacement surgeries between 2011 and 2016, we used causal graphical modeling on electronic health record data. The Fast Causal Inference (FCI) algorithm from the Tetrad software was used on data to estimate a Partial Ancestral Graph (PAG) depicting direct and indirect causes of postoperative length of stay, given background clinical knowledge. Then, we used the latent variable intervention-calculus when the directed acyclic graph is absent (LV-IDA) algorithm to estimate strengths of causal effects of interest. Finally, we ran a linear regression for postoperative length of stay to contrast statistical associations with what was learned by our causal analysis. ResultsIn our cohort of 2610 patients, the mean postoperative length of stay was 219 hours compared with the Society of Thoracic Surgeons 2016 national mean postoperative length of stay of approximately 168 hours. Most variables that clinicians believe to be predictors of postoperative length of stay were found to be causes, but some were direct (eg, age, diabetes, hematocrit, total operating time, and postoperative complications), and others were indirect (including gender, race, and operating surgeon). The strongest average causal effects on postoperative length of stay were exhibited by preoperative dialysis (209 hours); neuro-, pulmonary-, and infection-related postoperative complications (315 hours, 89 hours, and 131 hours, respectively); reintubation (61 hours); extubation in operating room (–47 hours); and total operating room duration (48 hours). Linear regression coefficients diverged from causal effects in magnitude (eg, dialysis) and direction (eg, crossclamp time). ConclusionsBy using retrospective electronic health record data and background clinical knowledge, causal graphical modeling retrieved direct and indirect causes of postoperative length of stay and their relative strengths. These insights will be useful in designing clinical protocols and targeting improvements in patient management.

Burden of cardiovascular disease in a large contemporary cohort of patients with heterozygous familial hypercholesterolemia

Background and aimsHeterozygous familial hypercholesterolemia (HeFH) is increasingly better diagnosed and treatments can improve the cardiovascular prognosis. We evaluated the long-term cardiovascular risk of HeFH using the French REgistry of Familial hypERCHOLesterolemia (REFERCHOL). MethodsWe studied HeFH patients diagnosed genetically and clinically by the Dutch Lipid Clinic Network (DLCN) criteria in all lipid clinics across the country and their 5-year risk of cardiovascular events (all fatal and non-fatal acute coronary, cerebral and peripheral arterial disease events, aortic valve replacement surgery) using the French national health data system. ResultsThe database comprised 3202 individuals, 2010 (62.8%) with genetically verified HeFH and 1192 (37.2%) a DLCN score ≥6. Of these individuals, 2485 (77.6%) were in primary prevention and 717 (22.4%) in secondary prevention. The incidence of cardiovascular events was 24.58 per 1000 person-years for the overall sample, 19.15 in primary prevention and 43.40 in secondary prevention. The incidence of myocardial infarction, cerebral infarction and death was 16.32 per 1000 person-years for the overall sample, 12.93 in primary prevention and 28.08 in secondary prevention. The incidence of aortic valve replacement was 1.78 per 1000 person-years. In the overall sample, at inclusion, 41% were not treated for LDL cholesterol, 48% of these in primary prevention and 20% in secondary prevention and high-dose statins were used by only 24% of individuals, 15% of these in primary prevention and 45% in secondary prevention. ConclusionsThe incidence of cardiovascular events in HeFH is high and lipid-lowering treatment is far from optimal. The cardiovascular risk of HeFH is underestimated and patients are inadequately treated.

A Potentially Fatal Inflammation of the Heart: A Case Report

At the beginning of the COVID-19 pandemic, many people delayed care for major medical conditions, leading to more severe complications. There was a pervasive fear of being exposed to COVID-19 when going to a hospital emergency department. In this case, a 35-year-old female patient that had scheduled monthly appointments presented by video telehealth visit with almost a week of body aches associated with fever, chills, finger swelling, and dehydration. Her vitals were consistent with sepsis, and she was immediately instructed to go to the emergency department. At the hospital, she was found to have sepsis secondary to bacteremia from her port-a-cath, leading to infective endocarditis and organ abscesses. She eventually had to undergo major cardiac surgery for aortic valve replacement. Even though she realized her symptoms were concerning, she was afraid of going to the hospital and contracting COVID-19. Instead, she waited for her outpatient appointment, and this resulted in her having more severe complications. However, not a diagnosis of COVID-19, the delays in care from fear of contracting this novel disease led to many adverse outcomes in other medical conditions.

A Pilot Study to Assess the Clinical Onset of IV Heparin in Interventional Cardiology and Cardiac Surgery

To determine the onset of heparin anticoagulation, using 2 different measures of activated clotting times (ACT), thromboelastography (TEG; R-time), and anti-Xa levels, after administering low- (100 U/kg) and high- (300 U/kg) dose intravenous (IV) heparin to patients undergoing transcatheter aortic valve replacement (TAVR) and cardiac surgery, respectively. Prospective study. Single academic institution. Patients with normal baseline coagulation presenting for TAVR or cardiac valve surgery. Coagulation studies were performed at baseline, 30 seconds, 90 seconds, and 180 seconds after IV heparin administration. The tests included iSTAT (iACT) and Hemochron ACT (hACT), TEG R-Time, and anti-Xa levels. At the authors' institution, anti-Xa is the preferred measure of heparin anticoagulation when time permits. ACT, a rapid point- of-care test, is used to assess intraprocedural anticoagulation. After both low- and high-dose heparin, there are peak increases in ACT and anti-Xa at 30 seconds, followed by a decline at 90 seconds and plateau at 180 seconds. The TEG R-time remained elevated (>80 minutes) throughout. For TAVR cases, all anti-Xa was >1.5 IU/mL, and was associated with an iACT >180 seconds and an hACT >200 seconds. For cardiac valve surgery cases, all anti-Xa was >2.4 and associated with an iACT >420 seconds and and hACT >340 seconds. Compared with hACT, iACTs were significantly lower at all time points after low-dose heparin, but not after high-dose heparin. In this pilot study, heparin anticoagulation was detected as early as 30 seconds after IV administration, based on ACT, anti-Xa levels, and TEG R-time.

Comparison of the Use of Desflurane vs. Propofol in Aortic Valve Replacement Surgery: Differences in Nephroprotection: An Explorative and Hypothesis-Generating Study.

Introduction: The cardioprotective effect of halogenated drugs in cardiac surgery has been the subject of several studies. However, there is scarcity of data on their potential nephroprotective effects. Aortic valve replacement and coronary revascularization are the most frequent cardiac surgery procedures. The objective of this explorative study was to examine the effect of desflurane vs. propofol on renal function, when administered in aortic valve replacement surgery, including the extracorporeal circulation period. Method: A quasi-experimental prospective study was performed in 60 patients, who were allocated to receive either desflurane or propofol intraoperatively during aortic valve replacement surgery. As a hypnotic, group 1 received propofol, whereas group 2 received desflurane. Markers of renal function and level of cardiac preservation were determined based on biochemical parameters (troponin I, NTProBNP). Results: In the propofol group, there were significant variations between postoperative values of urinary NGAL and creatinine and baseline values. In contrast, no variations were found in the desflurane group in terms of hemodynamic parameters and myocardial damage. Conclusions: The use of propofol vs. desflurane during aortic valve replacement surgery is associated with a decrease in renal function.

Objectively measured preoperative physical activity and sedentary behaviour among Finnish patients scheduled for elective cardiac procedures: baseline results from randomized controlled trial

BackgroundWe investigated preoperative physical activity (PA) and sedentary behaviour (SB) in patients scheduled for elective cardiac procedures and compared them with population-based sample of Finnish adults.MethodsCardiac patients (n = 139) undergoing cardiac operations carried a triaxial accelerometer for seven days during the month before the procedure. Patients were categorised into four groups according to the procedure: percutaneous coronary intervention or coronary angiography (PCI-CA), coronary artery bypass grafting (CABG), aortic valve replacement (AVR) and mitral valve surgery (MVS). The raw accelerometer data was analyzed with dedicated algorithms to determine metabolic equivalents (METs, 3.5 mL/kg/min of oxygen consumption) of PA. The intensity of PA was divided into two categories: light (LPA, 1.5–2.9 METs) and moderate-to-vigorous (MVPA, ≥ 3.0 METs), while SB represented intensity < 1.5 MET without movements. SB and PA were described as daily means and accumulation from different bout lengths. Daily standing, steps and mean and peak MET-values were calculated. The results were compared between the patient groups and against the reference group from a population-based study FinFit2017.ResultsCardiac patients had fewer daily steps than the FinFit population (p = 0.01), and less SB accumulating from < 20 min bouts (p = 0.002) but more from 20 to 60 min bouts (p = 0.002). Particularly, CABG group had less daily MVPA (p = 0.002) and MVPA accumulating from > 10 min bouts (p < 0.001) than the FinFit population.ConclusionsWe found large differences in PA and SB between the patient groups and the FitFit population, CABG group having the worst activity profile. Also, the variation within the patient groups was wide, which should be considered to individualise the rehabilitation programs postoperatively.Trial registration clinicaltrials.gov (NCT03470246). Registered 19 March 2018, https://clinicaltrials.gov/ct2/show/NCT03470246.

Clinical Evaluation of on-Table Extubation in Patients Aged Over 60 Years Undergoing Minimally Invasive Mitral or Aortic Valve Replacement Surgery.

AimsTo evaluate the clinical efficiency of on-table extubation (OTE) versus delayed extubation in patients aged over 60 years that underwent minimally invasive mitral or aortic valve replacement surgery and evaluate the factors associated with successful OTE implementation.MaterialsPatients over 60 years with mitral or aortic valve disease who received minimally invasive mitral or aortic valve replacement surgery from October 2020 to October 2021 were selected retrospectively. We divided patients into the on-table extubated (OTE) group (n = 71) and the delayed extubation (DE) group (n = 22). Preoperative, intraoperative, and postoperative clinical variables were compared between the two groups.ResultsPatients in the DE group underwent longer surgery time, longer aortic occlusion clamping time and longer cardiopulmonary bypass time than those in the OTE group(217.48 ± 27.83 vs 275.91 ± 77.22, p = 0.002; 76.49 ± 16.00 vs 126.55 ± 54.85, p = 0.001; 112.87 ± 18.91 vs 160.77 ± 52.17, p = 0.001). Patients in the OTE group had shorter postoperative mechanical ventilation time (min), shorter ICU time, shorter postoperative hospital length of stay and lower total cost and medication cost (p < 0.05). The AUC for aortic occlusion clamping time was 0.81 (p < 0.01), making it the most significant predictor of on-table extubation success.ConclusionsOn-table extubation following mitral or aortic valve cardiac surgery was associated with a superior clinical outcome and high cost-effectiveness.

The value of preservation of subvalvular structures in patients with mitral and aortic valve replacement surgery and its effect on left ventricular contractility

Objective: To discuss the clinical value of preserving subvalvular structure in mitral and aortic valve replacement surgery and its effect on left ventricular contractility. Methods: A total of 97 patients who underwent mitral valve replacement surgery in the Adult Cardiac Surgery of Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital from June 2016 to December 2018 were selected as the research subjects, of whom 45 cases were preserved subvalvular structure and 52 cases were in the total resection group (intraoperative total resection of the mitral valve and subvalvular chordae tendineae). General cardiac function indexes and left ventricular function quantitative indexes were compared before and in 3 months and 6 months after the operation of the two groups; The changes of the overall longitudinal strain of the long axis of the apex and the overall circumferential strain of the short axis of the left ventricle determined by the two-dimensional speckle tracking technology were compared before and after the operation. Results: The ages of the patients in the preservation group and the total resection group were (41.8±11.3) and (43.3±10.6) years old, respectively, and the male proportions were 58.0% (26 cases) and 44.0% (23 cases), respectively, with no significant difference (all P>0.05). The aortic occlusion time and cardiopulmonary bypass time of the patients in the preservation group were (57.8±4.5) and (78.6±6.7) min, respectively, which were longer than those in the total resection group [(48.1±4.4) and (48.1±4.4) min, respectively] (all P<0.05). The left atrial pressure of the patients in the preservation group at shutdown was (8.4±1.8) mmHg (1 mmHg=0.133 kPa), which was lower than that of the total resection group (11.3±2.5) mmHg (P<0.001). There were interaction effects between groups and time in regards to the left ventricular end-diastolic diameter ( LVEDD ), left ventricular ejection fraction ( LVEF ) and Tei index, as well as the strain rate of mitral annulus and left ventricular wall of interventricular septum of the preservation group and the total resection group (all P<0.05). LVEDD and LVEF of patients in the preservation group at 3rd month after operation were (44.7±4.0) mm and (45.5±4.2) mm, and at 6th months were (56.5±4.9)% and (58.8±5.0)%, respectively, all larger than (42.7±3.6) mm and (42.7±3.6) mm, (54.5±4.6)% and (56.3±4.8)% of the total resection group. The measured value of LVESD in the preservation group at 3rd month after surgery was (32.6±3.2) mm, which was greater than that in the total resection group (31.2±3.4) mm (P<0.05). The Tei index of patients in the preservation group at 3rd and 6th months after surgery were 1.0±0.2 and 0.8±0.2, respectively, which were lower than those in the total resection group 1.2±0.3 and 0.9±0.2 (all P<0.05). Conclusion: Preserving the subvalvular structure during mitral valve replacement surgery can better improve the patient's left ventricular function and left ventricular systolic capacity.

Aortic stenosis above 70, conventional aortic valve replacement vs trans catheter aortic valve implantation (TAVI)

Background: The prognosis is not good for those who have severe aortic stenosis with symptoms. In adults who have significant symptoms caused by aortic stenosis, surgical replacement of the aortic valve has been the treatment of choice up until quite recently. Objective: to accurately compare the surgical process and initial results of the more invasive standard sternotomy with the less invasive TAVI approach in elderly patients with isolated aortic valve disease who needed surgery in accordance with the inclusion criteria.Patients and method: Our research was a retrospective comparative analytical investigation that was carried out on forty patients who were above the age of seventy and suffered from severe aortic stenosis. The study was conducted at the National Heart Institute as well as other hospitals. Fifty percent of the participants were candidates for aortic valve replacement surgery via traditional median sternotomy, and the other fifty percent were candidates for trans-catheter aortic valve implantation (TAVI). Results: There was statistically insignificant difference between the two groups in terms of death after surgery, stroke, acute kidney injury, complete heart block requiring ppm, re-intervention, or bleeding.

Ascending Aortic Pseudoaneurysm: A Rare Complication of Transcatheter Aortic Valve Replacement and Thoracic Surgery.

Ascending Aortic Pseudoaneurysm: A Rare Complication of Transcatheter Aortic Valve Replacement and Thoracic Surgery.

A new heart surgery clinic: results of 67 open heart surgery in the first year

Aim: The aim of this study is to evaluate the results of 67 open heart surgeries performed in the first year in a new cardiovascular surgery clinic.Material and Method: Patients who underwent open heart surgery in our clinic between May 2021 and May 2022 were evaluated retrospectively. The hospitalization time, cross-clamp time, complications and mortality data of the patients were obtained retrospectively from the hospital database. In the analysis of the data, mean values were calculated for continuous variables, while percentage and frequency values were shown for categorical variables.Results: A total of 67 cases were included in the study. Isolated CABG surgery was performed on 44 patients with cardiopulmonary bypass (CPB). Isolated CABG surgery was performed on 3 patients without CPB (beating heart). CABG and mitral valve replacement (MVR) operations were performed simultaneously in two patients. MVR operation and tricuspid valve annuloplasty operations were performed simultaneously in two patients. MVR surgery was performed in four patients in isolation. Aortic valve replacement (AVR) operation was performed in 6 patients in isolation. Ascending aorta replacement was performed in three patients simultaneously with AVR operation. Bentall surgery was performed in two patients, and intra-cardiac tumor (myxoma) excision surgery was performed in one patient. Bleeding revision surgery was performed in one patient (1.5%) on the same day due to early bleeding and pericardial tamponade. Sternal dehiscence was observed in two patients in the late period (3%). Postoperative mortality was seen in a total of four patients (5.9%).Conclusion: As a result of our study, we determined that the surgeries performed in our newly opened cardiovascular clinic may have similar results to experienced clinics in terms of mortality and morbidity.

Dissecting aortic aneurysm after prosthetics of the bicuspid aortic valve

The article discusses the problems of bicuspid aortic valve and associated valvulo-aortopathy, including the principles of separate classifications, mechanisms and risk factors of aortic dilatation formation, indications for surgical treatment and type of surgery. A clinical case of the patient with L-R variant of the 1st type of this defect is presented. The valvular pathology she was diagnosed at the age of 24 and aortic valve replacement operation was performed at the age of 34 due to its severe insufficiency. Before the operation, the diameter of the ascending aorta was 4,8 cm, and after 7 years, control echocardiography showed pronounced dilatation of the ascending aorta with signs of dissection. This confirms the opinion about different mechanisms of the formation of this defect and related aortopathy and proves that the latter is caused not only by hemodynamic factors, as it progresses significantly after isolated aortic valve replacement, requiring repeated surgical intervention. An important predictor of aortic diameter growth is pronounced aortic insufficiency at baseline, and the risk factors are hypertension and smoking in past.

Successful aortic root enlargement procedure in low resource setting: Two rare cases.

BackgroundSmall aortic root is an unexpected incident during surgical aortic valve replacement in which the prosthesis valve size does not match the case being treated.Case presentationTwo patient-prosthesis mismatches with aortic valve problems underwent surgical aortic valve replacement. Based on calculating the body surface area (BSA) and effective orifice area (iEOA), the selection of prosthesis valve size was determined. When minor aortic root surgery was performed, it was discovered that the procedure of aortic root enlargement had to be conducted. The surgery went smoothly, but both patients had different outputs. The first patient was dead, while the second patient had a better quality of life.DiscussionEvery surgical aortic valve replacement preparation of aortic root enlargement procedure needs to be prepared for the worst-case scenario.ConclusionAortic root enlargement procedure must be anticipated in aortic valve replacement, especially for the patients with small aortic roots, both isolated and with concomitant valve procedure.