Vol. 25 No. 4 (2021)
CASE REPORTS

Bentall–De Bono procedure for aortic regurgitation and intraoperative rupture of moderately dilated ascending aorta: A case report

PDF (Русский)
  • S.Yu. Boldyrev,
  • M.A. Marukyan,
  • V.N. Suslova,
  • K.O. Barbukhatti,
  • V.A. Porkhanov
S.Yu. Boldyrev
Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1, Krasnodar; Kuban State Medical University, Krasnodar
Bio
M.A. Marukyan
Kuban State Medical University, Krasnodar
V.N. Suslova
Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1, Krasnodar
K.O. Barbukhatti
Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1, Krasnodar; Kuban State Medical University, Krasnodar
V.A. Porkhanov
Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1, Krasnodar
DOI: https://doi.org/10.21688/1681-3472-2021-4-106-111

Published 2021-12-28

Keywords

  • aortic dilatation,
  • aortic regurgitation,
  • aortic root aneurysm,
  • ascending aorta,
  • ascending aortic dissection,
  • clinical case,
  • thoracic aorta
    • ...More
    Less

How to Cite

Boldyrev, S., Marukyan, M., Suslova, V., Barbukhatti, K., & Porkhanov, V. (2021). Bentall–De Bono procedure for aortic regurgitation and intraoperative rupture of moderately dilated ascending aorta: A case report. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 25(4), 106–111. https://doi.org/10.21688/1681-3472-2021-4-106-111

Copyright (c) 2021 Boldyrev S.Yu., Marukyan M.A., Suslova V.N., Barbukhatti K.O., Porkhanov V.A.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

We herein present a clinical case of root and ascending aortic replacement in a patient with borderline enlargement of the ascending aorta and aortic valve insufficiency. A 65-year-old man was admitted to our clinic with signs of heart failure. Subsequent echocardiography and contrast-enhanced computed tomography revealed hemodynamically significant aortic insufficiency, as well as expansion of the ascending aorta. Diameter at the levels of the sinuses of Valsalva, sinotubular junction and tubular portion of the ascending aorta were 48, 47 and 44 mm, respectively. Based on the aforementioned data, indications for isolated aortic valve replacement were determined. Although the main portion of the surgery was unremarkable, at its final stage, a rupture of a section of the ascending aorta occurred. The results of intraoperative express histological examination of the enlarged aorta revealed connective tissue dysplasia and cystic median necrosis. Replacement of the ascending aorta was performed using the modified Bentall–De Bono technique. This case demonstrated that a borderline aortic dilatation of 40–50 mm at the ascending aorta was associated with pathological changes in its wall, which can cause fatal complications (rupture and dissection) and may require a more aggressive approach during surgical correction. Intraoperative express histological examination of the wall of the ascending aorta in ambiguous situations can help determine the scope of the intervention.

Received 16 March 2021. Revised 14 September 2021. Accepted 15 September 2021.

Funding: The study did not have sponsorship.

Conflict of interest: The authors declare no conflict of interest.

Contribution of the authors
Literature review: S.Yu. Boldyrev, M.A. Marukyan
Drafting the article: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova
Critical revision of the article: S.Yu. Boldyrev, V.A. Porkhanov
Surgical treatment: S.Yu. Boldyrev, M.A. Marukyan
Final approval of the version to be published: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova, K.O. Barbukhatti, V.A. Porkhanov

PDF (Русский)

References

  1. Hiratzka L.F., Bakris G.L., Beckman J.A., Bersin R.M., Carr V.F., Casey D.E. Jr, Eagle K.A., Hermann L.K., Isselbacher E.M., Kazerooni E.A., Kouchoukos N.T., Lytle B.W., Milewicz D.M., Reich D.L., Sen S., Shinn J.A., Svensson L.G., Williams D.M.; American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27-e129. PMID: 20359588. https://doi.org/10.1016/j.jacc.2010.02.015
  2. Erbel R., Aboyans V., Boileau C., Bossone E., Bartolomeo R.D., Eggebrecht H., Evangelista A., Falk V., Frank H., Gaemperli O., Grabenwöger M., Haverich A., Iung B., Manolis A.J., Meijboom F., Nienaber C.A., Roffi M., Rousseau H., Sechtem U., Sirnes P.A., von Allmen R.S., Vrints C.J.M.; ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873-2926. PMID: 25173340. https://doi.org/10.1093/eurheartj/ehu281
  3. Baumgartner H., Falk V., Bax J.J., De Bonis M., Hamm C., Holm P.J., Iung B., Lancellotti P., Lansac E., Rodriguez Muñoz D., Rosenhek R., Sjögren J., Tornos Mas P., Vahanian A., Walther T., Wendler O., Windecker S., Zamorano J.L.; ESC Scientific Document Group. 2017 ESC / EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-2791. PMID: 28886619. https://doi.org/10.1093/eurheartj/ehx391
  4. Hagan P.G., Nienaber C.A., Isselbacher E.M., Bruckman D., Karavite D.J., Russman P.L., Evangelista A., Fattori R., Suzuki T., Oh J.K., Moore A.G., Malouf J.F., Pape L.A., Gaca C., Sechtem U., Lenferink S., Deutsch H.J., Diedrichs H., Marcos y Robles J., Llovet A., Gilon D., Das S.K., Armstrong W.F., Deeb G.M., Eagle K.A. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897-903. PMID: 10685714. https://doi.org/10.1001/jama.283.7.897
  5. Kim J.B., Spotnitz M., Lindsay M.E., MacGillivray T.E., Isselbacher E.M., Sundt T.M. 3rd. Risk of aortic dissection in the moderately dilated ascending aorta. J Am Coll Cardiol. 2016;68(11):1209-1219. PMID: 27609684. https://doi.org/10.1016/j.jacc.2016.06.025
  6. Qin W., Li L., Li J., Su C., Huang F., Chen X. The fate of mild to moderate proximal aortic dilatation after isolated aortic valve replacement in tricuspid aortic valve patients. J Card Surg. 2019;34(11):1208-1214. PMID: 31441553. https://doi.org/10.1111/jocs.14217
  7. Papakonstantinou N.A., Rorris F.-P. Elective replacement of the ascending aorta: is the 5.5-cm threshold appropriate? The insidious, small aorta. Eur J Cardiothorac Surg. 2021;59(3):554-561. PMID: 33226084. https://doi.org/10.1093/ejcts/ezaa387
  8. Matthias Bechtel J.F., Noack F., Sayk F., Erasmi A.W., Bartels C., Sievers H.-H. Histopathological grading of ascending aortic aneurysm: comparison of patients with bicuspid versus tricuspid aortic valve. J Heart Valve Dis. 2003;12(1):54-59; discussion 59-61. PMID: 12578337.
  9. Kälsch H., Lehmann N., Möhlenkamp S., Becker A., Moebus S., Schmermund A., Stang A., Mahabadi A.A., Mann K., Jöckel K.-H., Erbel R., Eggebrecht H. Body-surface adjusted aortic reference diameters for improved identification of patients with thoracic aortic aneurysms: results from the population-based Heinz Nixdorf Recall study. Int J Cardiol. 2013;163(1):72-78. PMID: 21641667. https://doi.org/10.1016/j.ijcard.2011.05.039
  10. Zafar M.A., Li Y., Rizzo J.A., Charilaou P., Saeyeldin A., Velasquez C.A., Mansour A.M., Bin Mahmood S.U., Ma W.-G., Brownstein A.J., Tranquilli M., Dumfarth J., Theodoropoulos P., Thombre K., Tanweer M., Erben Y., Peterss S., Ziganshin B.A., Elefteriades J.A. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. J Thorac Cardiovasc Surg. 2018;155(5):1938-1950. PMID: 29395211. https://doi.org/10.1016/j.jtcvs.2017.10.140
  11. Tozzi P., Gunga Z., Niclauss L., Delay D., Roumy A., Pfister R., Colombier S., Patella F., Qanadli S.D., Kirsch M. Type A aortic dissection in aneurysms having modelled pre-dissection maximum diameter below 45 mm: should we implement current guidelines to improve the survival benefit of prophylactic surgery? Eur J Cardiothorac Surg. 2021;59(2):473-478. PMID: 33006606; PMCID: PMC7850065. https://doi.org/10.1093/ejcts/ezaa351
  12. Kunzelman K.S., Grande K.J., David T.E., Cochran R.P., Verrier E.D. Aortic root and valve relationships. Impact on surgical repair. J Thorac Cardiovasc Surg. 1994;107(1):162-170. PMID: 8283879. https://doi.org/10.1016/S0022-5223(94)70465-1
  13. Evangelista A., Flachskampf F.A., Erbel R., Antonini-Canterin F., Vlachopoulos Ch., Rocchi G., Sicari R., Nihoyannopoulos P., Zamorano J.; European Association of Echocardiography; Document Reviewers; Pepi M., Breithardt O.-A., Plonska-Gosciniak E. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr. 2010;11(8):645-658. PMID: 20823280. https://doi.org/10.1093/ejechocard/jeq056
  14. Benedik J. Jr, Azhari P., Tsagakis K., Pilarczyk K., Indruch J., Baba H.A., Benedik J., Jakob H. Dissectometer — a new device for tensile strength testing of the vascular wall. Minim Invasive Ther Allied Technol. 2012;21(5):329-334. PMID: 22142184. https://doi.org/10.3109/13645706.2011.642076
  15. Болдырев С.Ю., Россоха О.А., Понкина О.Н., Барсук А.В., Терман Е.А., Барбухатти К.О., Порханов В.А. Новый подход к выбору метода реконструкции корня аорты: вклад гистологического исследования в хирургию аневризм восходящей аорты. Кардиология и сердечно-сосудистая хирургия. 2015;8(4):4-8. [Boldyrev S.Yu., Rossokha O.A., Ponkina O.N., Barsuk A.V., Terman E.A., Barbukhatti K.O., Porkhanov V.A. A new approach to the aortic root reconstruction: the role of histological examination in surgery of the ascending aortic aneurysms. Kardiologiya i Serdechno-Sosudistaya Khirurgiya = Russian Journal of Cardiology and Cardiovascular Surgery. 2015;8(4):4-8. (In Russ.)] https://doi.org/10.17116/kardio2015844-8