Ozaki Procedure Plus Aortic Annular Enlargement in an Extremely Narrow Aortic Annulus: A Surgical Challenge.

We report a 19-year-old woman with a history of percutaneous aortic valve (AV) balloon valvuloplasty 3 years ago. She was admitted with severe symptomatic AV stenosis with narrow aortic annulus. We decided to perform AV reconstruction with autologous pericardium. However, surgical findings revealed a very narrow AV annulus with a unicuspid valve; therefore, an AV enlargement was added.

Correlating possible predisposing demographics and systemic conditions with the aortic root.

Background: The aortic root is an aggregate of various components that connects the left ventricle to the aorta. The most predominant pathologies have been associated with the dilation of the aortic root leading to aneurysms. Aim: This study is designed to measure the role of systemic morbidities such as hypertension, diabetes, and body mass index (BMI) on the dimension of the aortic root. Materials and Methods: Participants were volunteers of African descent who were recruited during and after an organized health fair by the medical students' body from All Saints University, School of Medicine. 169 participants consisting of 62 males and 107 females with ages ranging from 9 to 84 years agreed to volunteer by signing the consent after which a questionnaire was administered and a preliminary clinical procedure was used to check for blood pressure (BP), blood glucose (BG), and BMI. The measurement of the aortic root was carried out by an experienced single investigator who was not aware of the purpose of measurements, using a DUS-5000 ultrasound machine (Miami, Florida, USA) at a low-frequency micro-convex transducer preset to "adult cardiac" with a default frequency of 4 MHz. Results: Among the participants, 35.03%, 47.80%, and 29.11% had normal BP, BG, and BMI readings, respectively. The Chi-squared analysis identified a significant correlation between the diameter of the aortic annulus (AA) and BMI. Diastolic BP is also correlated with the diameter of the AA. Sinus of Valsalva (SV) showed an unusual correlation with BG as opposed to BP and BMI. Conclusion: The disparity in how a systemic factor individually correlates with the AA and the SV is not clear. The study targets to provide educational concept in this regard.

RésuméContexte: La racine aortique est un agrégat de divers composants qui relie le ventricule gauche à l'aorte. Les pathologies les plus prédominantes ont été associées à la dilatation de la racine aortique conduisant à des anévrismes. But: Cette étude est conçue pour mesurer le rôle des morbidités systémiques telles que l'hypertension, le diabète et l'indice de masse corporelle (IMC) sur la dimension de la racine aortique. Matériel et méthodes: Les participants étaient des volontaires d'origine africaine qui ont été recrutés pendant et après une foire organisée de la santé par le corps des étudiants en médecine de l'école de médecine All Saints University. 169 participants, soit 62 hommes et 107 femmes âgés de 9 à 84 ans, ont accepté de faire du bénévolat en signant le consentement après l'administration du questionnaire et en utilisant une procédure clinique préliminaire pour vérifier la tension artérielle, la glycémie (glycémie), et BMI. La mesure de la racine aortique a été effectuée par un chercheur expérimenté qui ne connaissait pas le but des mesures, en utilisant une échographe DUS-5000 (Miami, Floride, USA) à un transducteur micro-convexe basse fréquence préréglé à "adultcardiac" avec une fréquence par défaut de 4 MHz. Résultats: Parmi les participants, 35,03%, 47,80% et 29,11% avaient respectivement des valeurs normales de BP, de BG et de BMI. L'analyse du khi carré a mis en évidence une corrélation significative entre le diamètre de l'anneau aortique (AA) et l'IMC. La pression artérielle diastolique est également corrélée avec le diamètre de l'AA.Sinus de Valsalva (SV) a montré une corrélation inhabituelle avec BG par opposition à BP et BMI. CONCLUSION: La disparité dans la façon dont un facteur systémique est individuellement corrélé avec l'AA et le SV n'est pas clair. L'étude vise à fournir un concept éducatif à cet égard.

Aortic Regurgitation in Acute Type-A Aortic Dissection: A Clinical Classification for the Perioperative Echocardiographer in the Era of the Functional Aortic Annulus.

The functional aortic annulus offers a clinical approach for the perioperative echocardiographer to classify the mechanisms of aortic regurgitation in acute type-A dissection. Comprehensive examination of the functional aortic annulus in this setting using transesophageal echocardiography can guide surgical therapy for the aortic root by considering the following important aspects: severity and mechanism of aortic regurgitation, extent of root dissection, and the pattern of coronary artery involvement. The final choice of surgical therapy also should take into account factors, such as patient presentation and surgical experience, to limit mortality and morbidity from this challenging acute aortic syndrome. This review explores these concepts in detail within the framework of the functional aortic annulus, detailed anatomic considerations, and the latest literature.

The functional aortic annulus in the 3D era: focus on transcatheter aortic valve replacement for the perioperative echocardiographer.

The functional aortic annulus represents a sound clinical framework for understanding the components of the aortic root complex. Recent three-dimensional imaging analysis has demonstrated that the aortic annulus frequently is elliptical rather than circular. Comprehensive three-dimensional quantification of this aortic annular geometry by transesophageal echocardiography and/or multidetector computed tomography is essential to guide precise prosthesis sizing in transcatheter aortic valve replacement to minimize paravalvular leak for optimal clinical outcome. Furthermore, three-dimensional transesophageal echocardiography accurately can quantify additional parameters of the functional aortic annulus such as coronary height for complete sizing profiles for all valve types in transcatheter aortic valve replacement. Although it is maturing rapidly as a clinical imaging modality, its role in transcatheter aortic valve replacement is seen best as complementary to multidetector computed tomography in a multidisciplinary heart team model.