[HSF] Bicuspid aortic valve and dilated ascending aorta

[David Harris]

For a simple AVR maybe this is so, but with a dilated
aorta, better exposure is needed. Also, is it not
difficult if the aortic valve is sitting deeper in the
heart (more caudal than usual)?

I agree 100% with Tom that this patient needs valve
plus ascending aorta replacement, with the emphasis
that a Bentall is not needed - unless the sinuses are
dilated.....keep it still as simple as possible, but
do a proper long term procedure.

Patients with aortas just below 4cm should be on
lifelong beta blockers, and still need surveillance of
their aortas - transthoracic echo yearly should be
sufficient.

For a non bicuspud valve and dilated aorta, the aorta
should also be replaced if it measures more than 4.5
cm (my approach), others would say ? 5cm. What do our
experts recommend for non bicuspid valves, in a non
Marfan patient?

Dave Harris
--- zzhoumd at pol.net wrote:

> You need to see the patient to believe, without
> sternotomy, in two weeks
> they can do anything. For AR, the surgery is not
> difficult at all.
> 
> 
> 
> > Sorry I have not responded to this earlier but I
> have been too busy
> > doing redo complete sternotomies for patients that
> had previous bicuspid
> > aortic valves replaced with "dilated" (4 cm)
> aortas.  That is supposed
> > to be funny but in reality I just did a redo in a
> patient that had a
> > bicuspid AVR several yrs ago and was refered to me
> with a 7 cm
> > ascending. I actually see quite a few pts also
> that have had previous
> > bicspid AVR's that come to us with acute
> dissections. Patients with
> > bicuspid aortic valves and dilated ascendings have
> abnormal collagen and
> > WILL have a problem in the future. My advice in
> this area is- at the
> > minimum AVR plus ascending if the aorta is 4cm or
> greater and if the
> > sinuses are significantly enlarged, do a root. As
> for the "mini"
> > sternotomy or minimally invasive approach to the
> aortic valve my
> > question is WHY!? There is no real benefit to the
> patient in any fashion
> > and it is harder to do.
> >
> > Tom Martin
> > U of Florida
> > Gainesville
> >
> >
> > -----Original Message-----
> > From: prasannasimha at gmail.com
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Mon, 23 Apr 2007 10:27 PM
> > Subject: Re: [HSF] Bicuspid aortic valve and
> dilated ascending aorta
> >
> >
> > 5.0 cm does not merit "prophylactic " replacement
> of the ascending
> > aorta.  Prasanna
> >
> > Zhandong Zhou wrote:
> >> To Forum,
> >>
> >> I have a 51 year old patient with bicuspid aortic
> valve, severe AR >
> >> with 4.0 cm root. choices between mini-invasive
> AVR (through 2nd >
> >> intercostal space, 2.5 inch incision) vs full
> sternotomy with Bentall.
> >> > I personally prefer mini AVR then see what
> happens in the future.
> >>
> >> Any suggestions?
> >>
> >> Z Zhou
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Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411             
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