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Dissection in a pulmonary autograft
Edward H Kincaid1, James D Maloney, Sidney W Lavender
1Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. tkincaid@wfubmc.edu
The Annals of Thoracic Surgery
|February 5, 2004
Summary
Aortic dissection can occur in pulmonary autografts years after a Ross procedure. This case shows a type II dissection involving the native aorta and autograft, successfully treated by sparing the valve during reoperation.
Area of Science:
- Cardiovascular Surgery
- Aortic Diseases
- Cardiac Transplantation
Background:
- The Ross procedure, using a pulmonary autograft for aortic valve replacement, can be complicated by late aortic complications.
- Type II aortic dissection poses a significant risk to patients, particularly involving prosthetic or autograft materials.
Observation:
- A patient developed a type II aortic dissection involving both the native ascending aorta and the pulmonary autograft 6 years post-Ross procedure.
- The dissection flap extended into the right coronary sinus of the autograft, indicating extensive aortic wall involvement.
Findings:
- Reoperation successfully addressed the aortic dissection while preserving the pulmonary autograft valve.
- A root remodeling technique was employed to manage the dissection, avoiding graft replacement.
Implications:
- This case highlights the potential for late aortic dissection after Ross procedures and the feasibility of valve-sparing repair.
- Root remodeling offers a viable strategy for managing complex aortic dissections involving autografts, preserving native valve function.