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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Aortic Regurgitation I: Introduction

IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
Aneurysm I: Introduction01:30

Aneurysm I: Introduction

An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...

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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Transapical aortic valve replacement through a chronic apical aneurysm.

Enrico Ferrari1, Fabrizio Gronchi, Salah Dine Qanadli

  • 1Department of Cardiovascular Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland. enricoferrari@bluewin.ch

Interactive Cardiovascular and Thoracic Surgery
|December 14, 2011
PubMed
Summary

Transapical aortic valve replacement is safe through apical aneurysms lacking thrombi, especially when other access routes are unavailable. This approach offers a viable option for patients with complex vascular conditions.

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Devices

Background:

  • Transapical aortic valve replacement (TA-TAVR) is typically contraindicated through apical aneurysms due to embolization risks.
  • Chronic fibrotic apical aneurysms without thrombi present a lower risk profile for embolization.

Observation:

  • A 73-year-old patient with severe aortic valve stenosis, coronary artery disease, and peripheral vascular disease presented with a left ventricular apical aneurysm.
  • No alternative vascular access sites were suitable for standard aortic valve replacement procedures.

Findings:

  • The patient successfully underwent a transapical 26 mm Sapien™ XT stent-valve implantation.
  • The procedure utilized the fibrotic, akinetic apical wall of the aneurysm as the access route.
  • No evidence of systemic embolization was reported during or after the procedure.

Implications:

  • Transapical aortic valve replacement through chronic fibrotic apical aneurysms can be a safe and effective alternative access strategy.
  • This technique expands treatment options for patients with complex anatomy and limited vascular access.
  • Careful patient selection, particularly the absence of apical thrombi, is crucial for successful outcomes.