Case 72

Previous dissection, aortic valve resuspended and tube graft ascending aorta

A 62 year old gentleman who had a previous dissection with aortic valve resuspended and tube graft replacement of the ascending aorta represents with increasing breathlessness. Investigation reveals a dilated aortic root and gross aortic regurgitation. What would you do?

He needs:

An echocardiogram to rule out any mitral valve pathology.

A coronary angiogram to exclude any coronary artery disease.

A CT scan to evaluate whether just the root or any other part of the aorta is aneurysmal.

As just the root was aneurysmal and the had symptomatic gross aortic regurgitation, with normal coronary arteries and no other valvular pathology this gentleman needs an aortic root replacement.

As the arch is normal he could have arch and right atrial cannulation and the Dacron graft could be cross clamped. An alternative to cross clamping the Dacron graft could be to insert an endoport up the femoral artery, and inflate the balloon in the Dacron graft to occlude it! The graft could then be opened below the balloon.