Aortic Root Reconstruction in Patients with Turner Syndrome And Ascending Aorta Aneurism

Alexander A. Makushin, Vladimir A. Mironenko, Sergey V. Garmanov, Shagen A. Maitesyan, Iuri M. Archaia

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

Aim: to show the possible variety of the aortic root reconstruction by the modified Manouguian-Seybold-Epting methodology with different pathomorthological peculiarities of aortic valve and ascending aorta prosthesis in patients with Turner syndrome and ascending aorta aneurysm.

Material and methods: When reconstructing aortic roots, the technique of mitral-aortic continuation patch enlargement was used and was followed by aortic prosthesis implantation, appropriate to the surface area of the patient’s body. In our view, this technique proved to be more vivid in the following cases: patient K., 19 years, with acute dissection of ascending aorta aneurism in the presence of hypoplasia of the aortic root and main arteries with Turner syndrome and patient L., 14 years, with ascending aorta aneurism and similar syndrome. Both cases were treated with the technique of aortic root boring, when the patch was formed according to the aortic root pathomorthology and the necessary anastomosis of the right atrial appendage and paraconduit space during Bentall-De-Bono operation; the second case was managed by implanting small diameter prosthesis with suprocoronal prosthesis of ascending aorta.

Results: Patients were discharged in good condition and with satisfactory hemodynamic indicators. Echo parameters of patient L. at the time of discharge, left ventricle: EDV-58 mL, ESV-22 mL, EF-60%. Aortic prosthesis: peak pressure gradient-18 mm Hg, mean pressure gradient–8.4 mm Hg. Patient K, left auricle-3.1 sm, left ventricle: ESD-2.3 sm, EDD-4.0 sm ESV-18 mL, EDV-70 mL, SV-52 mL, EF-75%, diameter of ascending aorta conduit-24mm, paraconduit space 8-9 mm, without blood flow. Aortic prosthesis: peak pressure gradient-15 mm Hg, mean pressure gradient–7.9 mm Hg.

Conclusions: The variety of the principle, used by Manouguian-Seybold-Epting boring enabled successful aortic root reconstruction in patients with different pathomorthology of the latter and Turner syndrome. The present technique is applied by most of the cardiac surgeons in their practice of aortic root operating.