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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

37
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...
37
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

56
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...
56
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
31
Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

67
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...
67
Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

59
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...
59

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Related Experiment Video

Updated: Sep 26, 2025

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Aortic valve fenestration: respect it or fix it?

Nathanael Shraer1, Pouya Youssefi2, Jean-Luc Monin1

  • 1Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 19, 2022
PubMed
Summary

Aortic valve fenestrations, whether respected or fixed, do not impact reoperation or recurrent aortic insufficiency after repair. Standardized surgical techniques are key to successful outcomes in aortic valve repair.

Keywords:
AnnuloplastyAortic aneurysmAortic insufficiencyAortic valve repairFenestration

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Thoracic Surgery

Background:

  • Aortic valve repair aims to restore valve function and prevent complications like aortic insufficiency and the need for reoperation.
  • Fenestrations in the aortic valve are anatomical variations that may influence repair outcomes.
  • The impact of managing these fenestrations (respecting or fixing) on long-term results after aortic valve repair remains a subject of investigation.

Purpose of the Study:

  • To determine if aortic valve fenestrations, managed by either respecting or fixing them, are associated with recurrent aortic insufficiency or reoperation after aortic valve repair.
  • To evaluate the influence of fenestration management on survival and reoperation rates in patients undergoing aortic valve repair.

Main Methods:

  • A retrospective study included 618 patients who underwent aortic valve repair between 2003 and 2019.
  • Patients were categorized based on aortic insufficiency phenotypes and fenestration management (respected or fixed).
  • Propensity score matching was used to compare outcomes between patients with and without fenestrations, analyzing survival, reoperation incidence, and aortic insufficiency severity.

Main Results:

  • After propensity score matching, no significant differences in survival, cumulative incidence of reoperation, or aortic insufficiency grade were observed between patients with and without fenestrations at 9 years.
  • Both respected and fixed fenestrations showed similar outcomes regarding reoperation and aortic insufficiency.
  • Standardization of surgical approaches, including specific annuloplasty techniques based on the phenotype, significantly reduced the risk of reoperation.

Conclusions:

  • Aortic valve fenestrations, regardless of whether they are respected or fixed, are not independently associated with adverse outcomes like reoperation or recurrent significant aortic insufficiency.
  • The standardization of surgical techniques is a critical factor in achieving favorable long-term results after aortic valve repair.
  • These findings suggest that focusing on standardized repair strategies is more important than the specific management of fenestrations.