How to Control Subannular Hemorrhage during Aortic Root Enlarging Procedures

Abstract

We describe an effective suture technique to control the persistent subannular bleeding at the aortoventricular curtain in four patients with aortic stenosis and small annulus who underwent aortic root enlargement and patch reconstruction. This technique approximates the left atrial roof to the aortic root without the need for re-replacement of the aortic prosthesis or revision of the patch. Reintervention for aortic root, valve, or the residual aorta was not required.

Keywords

aortic stenosis - small aortic root - destroyed aortic annulus - subannular patch bleeding - aortoventricular rupture

• References

• 1 Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. The problem of aortic valve replacement. Thorax 1970; 25 (03) 339-346
• 2 Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique. J Thorac Cardiovasc Surg 1979; 78 (03) 402-412
• 3 Alameddine AK, Alimov VK, Flack JE. Repair of intervalvular fibrous body rupture during aortic valve replacement. J Card Surg 2011; 26: 372-374
• 4 Yacoub M, Onuzo O, Riedel B, Radley-Smith R. Mobilization of the left and right fibrous trigones for relief of severe left ventricular outflow obstruction. J Thorac Cardiovasc Surg 1999; 117 (01) 126-132 , discussion 32–33
• 5 Dhareshwar J, Sundt III TM, Dearani JA, Schaff HV, Cook DJ, Orszulak TA. Aortic root enlargement: what are the operative risks?. J Thorac Cardiovasc Surg 2007; 134 (04) 916-924
• 6 Morisaki A, Kato Y, Motoki M, Takahashi Y, Nishimura S, Shibata T. Rupture of equine pericardial aortic-root patch after aortic valve replacement with aortic annulus enlargement: a case report. J Cardiothorac Surg 2014; 9: 109
• 7 Fukuhara S, Dimitrova KR, Geller CM, Hoffman DM, Ko W, Tranbaugh RF. Left atrial dissection: etiology and treatment. Ann Thorac Surg 2013; 95 (05) 1557-1562