Dacron Patch Research Articles

Continuous betadine-bacitracin irrigation for vascular graft infections: A case series

The aim of the study was to conduct a retrospective chart review of patients who underwent betadine/bacitracin continuous irrigation (BBCI) for vascular graft infections (VGIs) to review its use as a treatment option. A retrospective chart review from 2013 to 2017 was conducted of patients with VGIs that were treated with BBCI postremoval of the infected graft. The BBCI is a continuous infusion of 0.25% betadine in normal saline at 0.3mL/kg/h for 48hours then followed by bacitracin infusion with a concentration of 50,000 units bacitracin/per liter normal saline at 0.3mL/kg/h for 72hours. Descriptive statistics were used to describe the sample. The nine adult patients who received postoperative BBCI had an age range of 30-81years, with average age of 58.8 years. Five of the subjects were females with four males. A total of nine patients with groin infections were identified, with two aortobifemoral bypasses, two axillofemoral bypasses, three femoral-femoral bypasses, one femoral artery pseudoaneurysm repair with Dacron patch, and one common femoral endarterectomy with Dacron patch. VGIs were identified from 10days up to 72months from the original vascular procedure. Six patients had negative wound cultures, while two had wound cultures positive for methicillin-resistant Staphylococcus aureus and one patient had positive culture for Escherichia coli. The length of time of BBCI ranged from 48 to 84hours with average of 57.6hours (standard deviation [SD]=12.7hours). The length of time of the bacitracin irrigation ranged from 30 to 72hours with average of 48.4hours (SD=14.9hours). All patients healed their groin wounds except for an 81-year-old patient with aortobifemoral bypass graft who developed ischemic bowel and expired. Patients received at least 6weeks of intravenous antibiotics followed by oral antibiotic suppression therapy for life. VGIs are a devastating complication associated with a high morbidity. BBCI provides an option for antiseptic irrigation of the vascular graft site postgraft removal to promote wound closure.

Management challenges of late presentation Dacron patch infection after carotid endarterectomy

An 83-year-old man presented 4 years after right carotid endarterectomy (CEA) with an infection of his prosthetic Dacron patch. Initial scans (CT angiogram and whole body labelled white cell scan)...

Commentary on “Late Dacron Patch Inflammatory Reaction After Carotid Endarterectomy”

Commentary on “Late Dacron Patch Inflammatory Reaction After Carotid Endarterectomy”

Late Dacron Patch Inflammatory Reaction after Carotid Endarterectomy

The aim was to analyse the incidence and presentation of carotid patch inflammatory reactions following carotid endarterectomy (CEA). This was a cohort study using a prospectively maintained database. All patients who underwent elective CEA at a tertiary vascular centre between 2002 and 2016 were included. Computed tomography scan angiogram, duplex scan, and leucocyte scintigraphy were used to assess patients with suspected inflammatory patch complications. Re-intervention procedures and outcomes were noted. Histopathology and organisms cultured from the harvested material during re-intervention were assessed. During the study period, 633 patients underwent elective CEA. Fifty-one underwent eversion endarterectomy: 111 did not require a patch, whereas 471 patients had a patch repair. Four hundred and twenty eight had a Dacron patch repair and 43 a biological patch. Eight patients returned with late Dacron patch inflammatory complications (1.3% of all CEA and 1.9% of Dacron patch closures) after a period ranging from 18 months to 7 years (mean 4.1±2.1 years). Seven of the eight patients underwent surgical re-intervention, and the eighth patient was deemed high surgical risk. One patient underwent a vein bypass, three had vein patch repair, one required internal carotid artery (ICA) ligation after patch excision, and two were managed by debridement, with omohyoid and sternomastoid muscle covering of the patch. The patient who required ICA ligation suffered a fatal stroke. The remaining patients had a satisfactory outcome. All patients showed evidence of foreign body reaction in pathological examination with no pathological organism cultured from swabs or tissue harvested during surgery. Late wound complications after CEA may be related to inflammatory reaction of the Dacron patch rather than infection. Infection should be excluded first. Reconstruction with vein is effective. However, debridement with sternomastoid and omohyoid muscle covering of the patch may be considered in high risk patients after exclusion of infection with regular follow-up.

Management of the ruptured sinus of valsalva aneurysmsa

Background: RSOV is associated with a dramatic onset of symptoms to a state of biventricular failure due to sudden volume overload. Controversies exist about RSOV repairs among various centers are the surgical approach (chamber involved, transaortic or both) and the closure technique (primary/ patch closure). There have been no clinical trials to show that one technique is superior to other. In the present study, we reviewed our 16 years’ experience with repair of RSOV through exclusive transaortic approach.Methods: 40 patients underwent RSOV repair through transaortic approach from January 2000 to December 2016. The mean age was 30.2 years. The origin of RSOV was right coronary sinus in 75% of cases and non-coronary sinus in 22.5% of cases. There was one giant calcified unruptured aneurysm arising from right coronary sinus. Right ventricle was most common chamber of rupture comprising 96.67% cases. All patients underwent transaortic repair of RSOV using dacron patch. VSD repair was done in 25% cases. Aortic valve replacement was done in 62.5% cases for moderate to severe AR.Results: There were 7.5% in hospital deaths with no late deaths. Inotropic and ventilatory support required for 3±1.6 days and 1.8±1.2 days respectively. The mean ICU stay and hospital stay was 3.5±1.6 days and 7.5±2.5 days respectively. None of the patient required permanent pacemaker implantation. The 37 survivors were followed up for 6.4±3.6 years; all had an improvement in functional NYHA class with superior results in those with no aortic regurgitation. 7.5% patients developed mild AR during follow up which medical management was done.Conclusions: Surgical treatment of ruptured sinus of Valsalva aneurysm using the transaortic patch technique has an acceptably low operative risk, lesser distortion of aortic valve and good long-term symptom-freedom survival. An early aggressive approach is recommended to prevent worsening of symptoms and more extensive disease.

Clinical analysis of different root treatment methods in acute Stanford type A aortic dissection

Objective: To discuss the perioperative and follow-up results of different surgical methods for acute Stanford type A aortic dissection patients and analyzed the results. Methods: The clinic data of 351 acute Stanford type A aortic dissection patients received surgical therapy at Department of Thoracic and Cardiovascular Surgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital from January 2008 to December 2015 were analyzed retrospectively. There were 272 male and 79 female patients, aging from 22 to 83 years with a mean age of (52±13) years. According to root size, aortic valve structure and the status of dissection involvement, these patients were devided into three major groups: 218 cases with root reconstruction using Dacron felts, 34 cases with root reconstruction concomitant with aortic valve resuspension repair and 99 cases in with Bentall procedure. Proper shape based on the status of dissection involvement of Dacron patch was cut and put between the middle and outerlayer of aorta, then inside the inner layerone band Dacron felt was sutured with the aorta and the new middle layer with Dacron patch as mentioned above. In some cases the prolapsed aortic valve was re-suspended to the aortic cusp. Clinical outcomes among the 3 procedures were compared by χ(2) test, Fisher's exact test, t test and analysis of variance. Results: Cardiopulmonary bypass, cross-clamp, and circulatory arrest times of all the patients were (250±78), (171±70) and (31±10) minutes, respectively. The 30-day mortality was 9.2%(33/351), while no difference among the 3 procedures (9.6%, 8.8% and 9.1%). In the average follow-up time of (26.0±23.0) months (range from 0.5 to 90.0 months), survival rates were similar among the 3 procedures (77.7%, 77.4% and 77.8%). Only one patient received redo Bentall procedure because of severe aortic regurgitation and dilated aortic root (diameter of 50 mm). Conclusions: The indication of root management of acute Stanford type A aortic dissection is based on the diameter of aortic root, structure of aortic leaflets, and the dissection involvement. For most acute Stanford type A aortic dissection patients, aortic root reconstruction is a feasible and safe method.

Ventricular Septal Defect with Pulmonary Valve Endocarditis with Vegetation - Successful Surgical Treatment in Apollo Hospitals Dhaka

Background: Pulmonary valve vegetation with ventricular septal defect needs early surgical intervention.Case presentation: A 21 years old man got admitted in Apollo Hospitals Dhaka, with the complaints of dyspnoea on exertion since childhood. Echocardiogram revealed a large perimembranous ventricular septal defect, moderate pulmonary stenosis, vegetation attached with pulmonary valve leaflet moving during systole & diastole. During operation ventricular septal defect was closed by dacron patch. Large vegetation was excised from anterior cusp of pulmonary valve. A perforation in right cusp of pulmonary valve was repaired with pericardial patch. Transesophageal Echocardiogram revealed well functioning ventricles and no leakage through the repaired Ventricular Septal Defect and pericardial patch in pulmonary valve leaflet.Result: Culture Sensitivity from vegetation showed no growth and histopathological examination revealed tissue consistent with vegetation of Pulmonary Valve. Post- operative echocardiogram showed no residual shunt or vegetation. The patient was discharged on 8th post operative day in good general condition and is doing well till now.Conclusion: Pulmonary valve endocarditis with vegetation with ventricular septal defect is a rare association. Early surgical intervention gives good outcome.Pulse Vol.9 January-December 2016 p.69-72

Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies.

Introduction and objectiveThe left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period.Materials and methodsBetween January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation.ResultsVarious surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery.ConclusionIn conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

An Alternative Aortotomy Technique for Aortic Valve Replacement in Porcelain Aorta

Porcelain aorta is extensive calcification of the ascending aorta that can be completely or near completely circumferential. Here we report a case of severe aortic stenosis and left anterior descending coronary osteal stenosis in a patient with a porcelain aorta. In this paper an alternative aortotomy approach; reverse “T” letter aortotomy incision is described for Type IB porcelain aorta. Patient underwent aortic valve replacement in addition coronary bypass grafting via sternotomy. The surgery and the postoperative course were uneventful and she was discharged at 7th day. This aortotomy technique prevents unnecessary and risky manipulations of extensive calcificated porcelain aorta, provides perfect exposure, and can be closed securely via dacron patch after aortic valve surgery. By the help of the described aortotomy technique, AVR can be the preferred choice in patients with porcelain aorta and multiple cardiac comorbidities requiring additional procedures, such as coronary bypass. Key words: Porcelain aorta, Aortic stenosis, Aortotomy.

Repair of Leaking Aortic Pseudoaneurysm due to Sternal Wound Infection in a Patient with CABG and Aorto-Axillary Bypass - A Case Report from Apollo Hospitals Dhaka

case of Aorto- axillary bypass graft site with CABG. Surgical intervention gives good result. Methods: A 55 years old gentleman came to our hospital with discharging chest wound with occasional episodes of bleeding through upper chest wound. One and half years back he was operated in another hospital with Aorto-axillary bypass with CABG. CT angiogram showed - Aorto- axillary bypass graft eroding sternum and developed a chronic leak in aortic side. Urgent operation was done on 1.08.13-we went to femoro-femoral bypass first-then very carefully sternotomy was done-found a leak around aortic side of the Aorto-axillary bypass graft. With gentle pressure on leak, proceeded for total circulatory arrest, graft was taken out, found oval shaped opening at ascending aorta, it was repaired by Dacron patch with continuous proline suture. Total circulatory arrest time was 37 minutes. Distal part of the graft on axillary artery found-a silk ligature applied-sternal wound reconstruction was done with pectoral is major muscle flap. Results: The patient remained very well in ICU and was discharged from hospital on 7th post operative day in good general condition. Now more than 1 years follow up he is doing very well. Conclusion: Graft leakage at aortic site of Aorto-axillary bypass graft is not a common entity, surgical intervention with Dacron patch repair gives good outcome. Surgical Repair of aortic pseudoaneurysm a though with high risk, is only remedy to save the life of the patient.

Management of Incidental Bochdalek Hernia in An Asymptomatic Adult: A Case Report

Bochdalek hernia is a type of Congenital Diaphragmatic Hernia (CDH) that typically presents in childhood. It rarely occurs in adults and most of them are asymptomatic. In this article, we report a case of a 30-year-old male with left-sided Bochdalek hernia who was incidentally diagnosed on chest radiograph. His chest radiograph showed features suggestive of left-sided diaphragmatic hernia, which was confirmed using contrast enhanced Computed Tomography (CECT) of chest and abdomen. The patient underwent left thoracotomy, wherein an 8x10 cm postero-lateral diaphragmatic defect with herniation of the small bowel, spleen, part of stomach, and colon with no peritoneal sac through the opening was found. The contents were reduced into the peritoneal cavity, although a part of omentum had to be sacrificed due to loss of domain and to achieve a tension free repair. The diaphragmatic defect was closed with Dacron patch and sutured to diaphragm with non-absorbable sutures.

Clinical application of heart dacron patch in facial nerve paralytic ectropion after the surgery of acoustic neuroma

Objective To investigate the clinical application of heart dacron patch for the treatment of facial nerve paralytic ectropion after the surgery of acoustic neuroma. Methods The subcutaneous tunnel incision on lower eyelid was made at supratemporal inner canthus ligament and lateral canthus respectively, the heart dacron patch was fixed at supratemporal inner canthus ligament and lateral canthus respectively to make the palpebral margin locating 2 mm above the corneoscleral limbus. Results The postoperative follow-up was 6-12 months. The facial nerve paralytic ectropion after the surgery of acoustic neuroma was entirely corrected in 17 cases. No shift or prolapse of the implant occurred. The patients were satisfied with the surgical effect. Conclusion Pocket surgery with heart dacron patch for the treatment of facial nerve paralytic ectropion after the surgery of acoustic neuroma was simple and effective with less injury. It is a good surgical operation. Key words: Ectropion, paralytic; Acoustic neuroma; Surgery, after; Pocket surgery, heart dacron patch

The Influence of Collagen Impregnation of a Knitted Dacron Patch Used in Carotid Endarterectomy

In selected populations, carotid endarterectomy (CEA) reduces long-term stroke risk. Studies have shown increased risk of restenosis with use of a collagen-impregnated Dacron patch compared to a polytetrafluorethylene patch. There is concern that collagen impregnation may initiate thrombosis or promote restenosis due to platelet activation. We performed a retrospective analysis of our CEA experience with routine patching using knitted Dacron patches with (Hemashield) and without (Sauvage) collagen impregnation. Our database was queried for all CEAs between January 2006 and December 2010. Seven surgeons performed 655 CEAs. Patients were excluded if no patch was used (n=1), a primary CEA was performed before study period or by other surgeons (n=11), or the patch type was indeterminable (n=38). Demographics, clinical data, and outcomes were compared between the collagen-impregnated (C, Hemashield) group and non-collagen-impregnated (NC, Sauvage) group. A total of 605 CEAs were analyzed (395 C and 210 NC). Demographics were similar except for coronary artery disease (C 54.3% vs. NC 41.6%, P=0.003). There was no statistically significant difference in 30-day (C 99.7% vs. NC 99.5%, P>0.99) or 5-year survival (C 80.0% vs. NC 83.7%, P=0.26) or 30-day stroke rate (C 0.3% vs. NC 1.0%, P=0.28). No late ipsilateral strokes occurred during 5-year follow-up. The 5-year freedom from restenosis >30% (C 85.3% vs. NC 86.4%, P=0.33), restenosis >50% (C 94.5% vs. NC 95.5%, P=0.44), and restenosis >70% (C 98.6% vs. NC 98.9%, P=0.73) were similar. Two patients underwent carotid stenting for restenosis >70%. Two patients (both in the C group) developed occlusion of the carotid artery. The thrombosis and restenosis rates in the 2 groups were similar. This suggests that collagen-impregnated patches do not initiate thrombosis or increase restenosis rates after CEA.

The extracellular matrix patch implanted in the right ventricle evaluated with cardiovascular magnetic resonance protocol to assess regional physio-mechanical properties.

An extracellular matrix patch was implanted in the porcine right ventricle for in situ myocardial regeneration. A newly developed cardiovascular magnetic resonance protocol was utilized to investigate the regional physio-mechanical function of the patch. Cardiovascular magnetic resonance was performed at 60-day after the porcine right ventricular wall full thickness substitution with an extracellular matrix cardiac patch (n = 5). Dacron patches and remote normal right ventricle served as control (n = 5/each). Late gadolinium enhancement, strain encoding and rest perfusion were measured for scar/patch detection, regional contractility and tissue perfusion. Image analyses were performed by two observers to validate interobserver reproducibility. All imaging sequences were successfully obtained. The patches were located with late gadolinium enhancement imaging in 95% accuracy. All the parameters demonstrated significant differences among extracellular matrix, Dacron and normal myocardium (P < 0.05), which correlated with histological findings, including constructive remodelling with nascent myocardium and profound vasculogenesis/angiogenesis in extracellular matrix patches, and scar formation in Dacron. Bland-Altman analysis demonstrated good interobserver reproducibility with minimal bias (strain encoding/peak strain: mean difference = -0.32%, 95% limits of agreement = -1.2 to 0.57, correlation = 0.97; rest perfusion/relative maximum upslope: mean difference = -0.74, 95% limits of agreement = -2.0 to 0.53, correlation = 0.92), along with excellent correlation obtained from linear regression (strain encoding: R2 = 0.93; rest perfusion: R2 = 0.85). With the cardiovascular magnetic resonance protocol, we successfully confirmed early signs of functional myocardial regeneration in implanted extracellular matrix patches. This approach is promising in assessing in situ regional physio-mechanical properties and degree of regeneration of implanted tissue-engineered materials.

Konno Operation: The 2015 Kyoto Symposium Konno Memorial Lecture.

The Konno operation consists of a prosthetic aortic valve replacement by using an anterior enlargement of the small aortic annulus. The original procedure includes a longitudinal incision in the aortic septum placed near the midpoint between the two coronary ostia, a vertical incision in the outflow tract of the right ventricle to join the septal incision, prosthetic aortic valve replacement, and patch reconstruction of the outflow tracts of both ventricles by means of a fusiform Dacron patch. The concept of this operation has been applied in other complex operations, such as modified Konno operation, Ross-Konno operation, and aortic valve replacement after arterial switch operation.

Studying the response of tissues of laboratory animals to implantation of vascular endoprostheses

&lt;p&gt;&lt;strong&gt;Aim:&lt;/strong&gt; The paper looks at one of pressing problems of angiosurgery, the choice of plastic material to be used in reconstructive interventions and focuses on the response of biological tissues to implantation of vascular endoprostheses. &lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; To do research on the study material, use was made of vascular dacron implant &amp;amp; a woven double velour vascular endoprosthesis of polyester fibers and impregnated with modified gelatin. 60 Vistar rats (males) weighing 200-250 g were chosen as study objects. The animals were assigned to 4 groups according to the number of firms-manufacturers and the time of removing from the experiment (at 15 and 30 days). Under general anesthesia in the operating room, the rats’ skin and subcutaneous fat were dissected along the paravertebral line. Two pouches 3.5 cm deep were formed in the subcutaneous fat by blunt dissection. A 2x2 cm sample of the vascular patch was introduced into each pouch. The surgical wound was closed completely and treated with antiseptics. Histological preparations were stained by using a hematoxylin-eosin/Mallory technique. The obtained microphotographs enabled us to evaluate the structure of the connective-tissue capsule, as well as the content of its cellular layer. A cellular index, the relationship between fibroblast cells and inflammatory infiltrate cells, was calculated in each group. The indicator exceeding 1 demonstrated the predominance of reparative tendencies, if it was below 1, inflammatory changes prevailed. Statistical processing of the data obtained was performed by means of descriptive and variation statistical methods. &lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; Changes of inflammatory reaction phases proceed faster in the zone of implantation of dacron patches, which manifest themselves by a reliable increase in the quantity of resident cells from 62.4% to 80.5% and a decrease in nonresident cells by 1.7 times on the same terms respectively. The reaction of fabrics is more expressed to a polyester implant, which is confirmed by an insignificant decrease from 53.5% to 43.7% of the quantity of inflammatory infiltrate cells and a growth of fibroblast cells from 46.5% (at 15 days) to 56.3% (at 30 days). &lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The reaction of tissues of laboratory animals is less expressed to a dacron implant.&lt;/p&gt;

Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy.

To investigate the feasibility and cosmetic results of a right subaxillary thoracotomy for closure of doubly committed subarterial ventricular septal defects. From October 2009 to September 2015, 78 patients [50 boys, 28 girls, mean age 4.7 ± 2.9 years (range, 0.5-15 years) and mean body weight 16.3 ± 9.6 kg (range, 7-42 kg)] with doubly committed subarterial ventricular septal defects were treated with minimally invasive surgical closure through a right subaxillary thoracotomy. All procedures were performed through an oblique 5- to 8-cm subaxillary mini-incision and the fourth intercostal space. The defect was approached through the main pulmonary artery or the right ventricular outflow tract. The defect was closed with a piece of Dacron patch or directly with one to two pledgetted polypropylene sutures. Additional procedures involved closure of atrial septal defects, closure of patent foramen ovale, mitral annuloplasty, tricuspid annuloplasty and relief of right ventricular outflow tract obstruction. The median cardiopulmonary bypass and aortic cross-clamp times were 51 ± 26.5 (33-78) and 27 ± 13.6 (15-46) min, respectively. The incision length was 6.7 ± 1.5 cm (range, 5.0-8.0 cm). The follow-up period was 37 ± 27.5 months (range, 6-72 months). The cardiac defect was repaired with a trivial to mild residual defect in 3 patients (2 patients with a small residual shunt and 1 with mild mitral regurgitation). No chest deformity or asymmetrical development of the breast was found. A right subaxillary thoracotomy, providing a feasible alternative to median sternotomy, can be performed with favourable cosmetic and satisfactory clinical results for closure of doubly committed subarterial ventricular septal defects.

Left ventricular assist device implantation in patients after left ventricular reconstruction.

Left ventricular assist device (LVAD) implantation can be challenging in patients with a prior surgical ventricular restoration (SVR). In this case series of heart failure patients with a history of SVR, we describe the surgical technique and outcome of a customized approach for inflow cannula orientation. Seven patients with a history of SVR with end-stage chronic heart failure were accepted for long-term LVAD support. In all patients, the Dacron patch was removed through left ventriculotomy and a Hegar 22 dilator was inserted at the estimated optimal position of the LVAD inflow cannula. The left ventricle was reconstructed around the dilator from the left ventricular (LV) apex to the base. Finally, the LVAD sewing ring was sutured onto the remaining apical defect and a HeartWare® LVAD was implanted. LVAD implantation was successful in all 7 patients. Transoesophageal echocardiography ensured an adequate LVAD position and inflow and outflow cannula Doppler flow recordings. The mean intensive care unit stay was 5.8 ± 2.6 days, and the hospital stay after surgery was 32 ± 16 days. All patients follow regular visits (follow-up 20 ± 16 months) at the outpatient clinic without any remarkable event. Using the technique described, LVAD implantation in patients after SVR is feasible and safe.

A Large, Unruptured, Aneurysm of Right Sinus of Valsalva, Extending Behind the Main Pulmonary Artery Associated with Bicuspid Aortic Valve-a Rarest Presentation

Background: Aneurysm of Sinus of valsalva is caused due to lack of the continuity between the middle layer of the aortic wall and aortic valves. Case report: A patient presented with dyspnoea and chest pain. Computed tomographic angiocardiography revealed dysplastic aortic valve and aneurysm of right sinus of valsalva. We presenting here a case with bicuspid aortic valve complicated with aneurysm of right sinus of valsalva. The aneurysm of sinus of valsalva was extracardiac and extending behind the main pulmonary artery and to the left. Computed tomographic angiocardiography revealed dysplastic aortic valve, para valvular aneurysmal sac communicating with aortic root as well as to left ventricle (? Pseudo-aneurysm). Opening of the aneurysm of sinus of valsalva was closed with Dacron patch from inside of the aorta. Aortic valve was replaced with sorin mechanical valve, size 21. Postoperative period was uneventful and patient was discharged on 7th postoperative day in good general condition. Patient is doing well in follow up visits. Discussion: This is associated with other heart defects, Ventricular septal defect in 30-60%, bicuspid valve (10%), and aortic stenosis (6.5%). Sinus of valsalva aneurysm recurrence per se is rare [1,2]. There is no doubt of the indication of surgical repair for symptomatic Sinus of valsalva aneurysm because this represents a significant risk of death. Operative mortality is generally low. Conclusion: This is the rare presentation of the aneurysm of right sinus of valsalva and is first time in literature because of following reasons. a. Aneurysm of sinus of valsalva was originating from the right sinus and was extending behind the main pulmonary artery. b. This was compressing the left anterior descending artery and causing angina like symptoms. c. This was associated with bicuspid aortic valve which is also a rare occurrence (10%) with aneurysm of sinus of valsalva.

The Influence of Collagen Impregnation of a Knitted Dacron Patch Routinely Used in Carotid Endarterectomy

The Influence of Collagen Impregnation of a Knitted Dacron Patch Routinely Used in Carotid Endarterectomy