Surgical treatment of aortico-left ventricular tunnel: a 12-year experience.

OBJECTIVES: This study reviews 9 patients with aortico-left ventricular tunnel (ALVT) and aims to establish the optimal surgical strategies for this exceptional and rare pathology. METHODS: 54,882 patients underwent open-heart surgery at the Fuwai Hospital between July 1996 and May 2008. Nine of these patients were diagnosed with ALVT. One patient died of acute heart failure before operation. The remaining 8 patients underwent operation. The mean age of these 8 patients was 22.5 years. Clinical, echocardiographic and surgical details were reviewed. RESULTS: At operation the diagnosis was confirmed, and then repaired by direct suture closure (n = 1), single patch closure of the aortic end of the ALVT (n = 4), or aortic valve replacement (n = 3). In 5 patients, the aortic opening of the tunnel was above the right coronary sinus of Valsalva while in the other 3 it was above the left coronary sinus. All patients recovered safely. There was 1 late death (from perivalvular leak). The remaining patients remain asymptomatic at a mean follow up of 30.1 months. CONCLUSIONS: ALVT is a rare cardiac entity that should be treated soon after the diagnosis is made. The specific surgical operation should be individualized based on unique cardiac anomaly of each patient.

[Surgical treatment of giant coronary artery aneurysm].

OBJECTIVE: To discuss the clinical features and surgical treatments of giant coronary artery aneurysm (CAA). METHODS: From July 1996 to October 2004, 6 giant CAA patients were underwent surgery at Fuwai hospital. Three cases were underwent CAA resection, 2 concomitant coronary bypass, 3 reconstruction. The giant CAA was often combined with other cardiac diseases. Four cases underwent additional procedures of fistula closure, 3 aortic valve replacements, 2 aortoplasty and 1 thrombus cleaning at the same time. RESULTS: All patients recovered uneventfully. The mean of cardiopulmonary bypass time was (144 +/- 26) min (range 67 to 207 min). Aortic cross clamping time was (104 +/- 21) min (range 56 to 172 min). Patients follow-up time occurred from 8 to 87 months (mean of 48 months). All patients were free of symptoms during follow-up. None of the patients died during the follow-up period and none of the CAA recurred. CONCLUSIONS: The giant CAA is a serious cardiovascular disease, early diagnosis and surgical treatment are mandatory.

[Valve-sparing aortic root replacement in patients with aortic root disease].

OBJECTIVE: To review the results of the valve-sparing operation (David procedure) in patients with aortic root disease. METHODS: Twenty-nine patients with aortic root disease, 20 males and 9 females, aged 39 +/- 17 (10-64), 10 being of heart functional class I, 15 of class II, and 4 of class III, and 15 with gentle, 9 with moderate, and 5 with severe aortic insufficiency underwent David procedure, one undergoing the aortic valve-sparing reimplantation (David I), 25 undergoing aortic valve-sparing remodeling (David II), and 3 undergoing a new modified aortic valve-sparing operation. After the operation the patients were followed up for 29 +/- 15 months (5-74 months). RESULTS: No intra-operative death was found. The mean extracorporeal circulation time was 126 min +/- 25 min, and the aortic crossclamp time was 87 min +/- 22 min. All patients recovered to heart functional class I. Post-operatively 11 patients showed no normal, eight gently and two moderate aortic regurgitation. CONCLUSION: The valve-sparing operation is an ideal operation to the aortic root aneurysm with more or less normal aortic leaflets and valvular ring normal.

Surgical treatment of giant coronary artery aneurysm.

OBJECTIVE: Giant coronary artery aneurysm is an extremely uncommon disease. Most previous reports have involved only single cases. This report describes 6 patients with giant coronary artery aneurysm, examines its causes, and aims to establish the optimal surgical strategies for this exceptional and rare pathology. METHODS: From July 1996 to October 2004, a total of 30,268 patients underwent heart surgery at Fuwai Hospital in Beijing. Among these, 6 patients had giant coronary artery aneurysm diagnosed and underwent operation. Various surgical strategies were used for the operations of these 6 patients, such as coronary artery aneurysm resection, coronary artery reconstruction, and concomitant coronary bypass. Additional procedures, such as fistula closure, aortic valve replacement, aortoplasty, and embolectomy, were done at same time for the patients with complications of coronary fistula, aortic valve insufficiency, or thrombus. Patients were followed up from 8 to 87 months, with a mean of 48 months. Doppler echocardiography, ultrafast computed tomography, and 3-dimensional aerial image studies were performed during follow-up. RESULTS: Five of these six cases were found combined with coronary artery fistula, and the cause for these giant coronary artery aneurysms was congenital. The remaining case was caused by atherosclerosis. After surgery, all patients recovered uneventfully, without in-hospital mortality. None died during the follow-up, nor did any have recurrence of the symptoms or giant coronary artery aneurysm. CONCLUSION: Giant coronary artery aneurysm is a rare entity that is commonly caused by congenital malformation and combined with other cardiac anomalies. An optimal surgical operation should be based on the specific cardiac anomaly of the individual patient.