Emergency Aortic Root Remodeling for Rupture of a Large Ascending Aortic Aneurysm
Etsuro Suenaga Hisao Suda Tsuyoshi Itoh*

(Department of Cardiovascular Surgery, Nagasaki Kouseikai Hospital, Nagasaki, Japan and Department of Thoracic and Cardiovascular Surgery, Saga Medical School*, Saga, Japan)

Aortic valve preservation is indicated in cases of aortic regurgitation caused by sinotubular junction (STJ) dilatation with ascending aortic aneurysm. We performed aortic remodeling using a tailored Dacron graft for the rupture of a large ascending aortic aneurysm. The patient was a 68-year-old woman. She was admitted in shock with cardiac tamponade. Chest CT showed a large ascending aortic aneurysm, 11 cm in maximum diameter. Echocardiography demonstrated moderate cardiac effusion and massive aortic regurgitation. The ascending aorta was dilated from the STJ to the innominate artery, but the aortic valve appeared normal. We decided to preserve the native aortic valve. We performed aortic root remodeling using a 26 mm Dacron graft (Yacoub's procedure). An intraoperative endoscopic study revealed the disappearance of aortic regurgitation (AR). The coronary arteries were reconstructed by the Carrel patch technique. Postoperative aortography revealed trivial AR, and the patient was discharged two weeks after the operation. We conclude that this technique avoids the complications associated with mechanical valve implantation and necessary lifetime anticoagulation.
@Jpn. J. Cardiovasc. Surg. 29: 410-413 (2000)