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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...
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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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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...
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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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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...
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Aortic Root Dissection Due to an Automated Fastener Device.

Ismael A Salas De Armas1, L Maximilian Buja2, Manish K Patel1

  • 1Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.

Texas Heart Institute Journal
|November 30, 2022
PubMed
Summary

A case report details a rare complication during minimally invasive aortic valve replacement. The Cor-Knot device may have caused an aortic root dissection due to suboptimal positioning, leading to postcardiotomy shock.

Keywords:
Aortic dissectionheart valveminimally invasive surgery

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Area of Science:

  • Cardiovascular Surgery
  • Medical Device Complications
  • Aortic Valve Disease

Background:

  • Minimally invasive aortic valve replacement (MIAVR) via right thoracotomy is a common procedure for aortic valve disease.
  • The Cor-Knot device is utilized to secure valve sutures during these procedures.
  • Postcardiotomy shock is a serious complication that can occur after cardiac surgery.

Observation:

  • A patient undergoing MIAVR developed postcardiotomy shock.
  • Surgical findings revealed a significant aortic root dissection (90% circumference) involving bilateral coronary ostia.

Findings:

  • Autopsy indicated the aortic dissection originated from a direct intimal tear caused by the Cor-Knot Device's distal shaft.
  • The device's suboptimal apposition to the sewing ring was likely due to anatomical constraints between the ribs.

Implications:

  • This case suggests a potential risk of aortic root injury with the Cor-Knot Device in challenging anatomical spaces during MIAVR.
  • Careful device placement and awareness of anatomical limitations are crucial to prevent severe complications like aortic dissection.