[Application and results of Robicsek procedure for dilated ascending aorta associated with aortic valve disease].

OBJECTIVE: To introduce the Robicsek procedure and summarize its short to mid-term results for patients with dilatation of the ascending aorta associated with aortic valve disease. METHODS: From December 2002 to June 2006, 30 patients with a moderately dilated ascending aorta [mean diameter, (46.7+/-3.1) mm] underwent concomitant aortic valve replacement (AVR) or repairing and reinforced aortoplasty with a well-tailored Dacron vascular graft. Follow-up was obtained on all patients with ultrasonic cardiography (UCG) or computed tomography (CT) scan and was (18.0+/-10.5) months. RESULTS: The total average cardio-pulmonary bypass (CPB) time was (103.4+/-21.7) min (80-151 min), and aortic arrest time was (73.0+/-21.6) min (48-120 min), whereas the average CPB time and aortic arrest time of 19 patients who underwent the isolated Robicsek procedure were only (91.3+/-8.9) min (80-118 min) and (61.6+/-11.3) min (48-82 min). No mortality occurred in the hospital. During follow-up of 18 months, no recurrent ascending aortic dilatation and dissection were observed, and the average aortic diameter was reduced to (33.7+/-2.5) mm. Sixteen of the 30 patients were diagnosed as bicuspid aortic valve (BAV). The ascending aortic media were histologically abnormal in 23 patients. CONCLUSION: Considering the underlying wall deficiency and the homodynamic stress, the Robicsek operation should be an optimal choice to those patients with a mild to moderate dilated ascending aorta caused by aortic valve lesion. Compared with the Bentall and David procedures, the Robicsek procedure could achieve the same or even better clinical results with less operative time and risks.

[Clinical analysis of pregnancy and postpartum cardiovascular complications in Marfan syndrome].

OBJECTIVE: To investigate the management of pregnancy and cardiovascular complications in women with Marfan syndrome (MFS). METHODS: From October 1994 to September 2006, 30 patients with MFS undergoing cardiovascular surgery were studied retrospectively. RESULTS: In the labor of 46 offsprings given birth by 30 women, 5 cases (11%) were performed elective cesarean section because of the existence of aortic complication, and 12 (26%) were diagnosed as MFS. The gestation in two patients was terminated due to deterioration of aortic abnormalities during their third trimester, and they received surgical treatment with Bentall procedure. Two developed acute aortic dissection during labor and post delivery respectively. With the manipulation of anticoagulation peripartum, one who had the implantation with mechanical prosthesis went through pregnancy and delivery uneventfully. The average duration between delivery and cardiovascular surgery was (15 +/- 9) years. CONCLUSIONS: Vaginal delivery can be done safely in patients with the MFS who do not have or have mild cardiovascular system abnormalities, aortic dissection, or other important cardiac abnormalities, cesarean section should be the preferred method of delivery. Women with MFS are at increased risk for dissection and congestive heart failure during pregnancy and should be counseled before pregnancy about these risks, as well as the inheritance of the condition.