Novel three-sinus enlargement technique for supravalvular aortic stenosis without aortic transection
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CASE REPORT
Open Access
Novel three-sinus enlargement technique for supravalvular aortic stenosis without aortic transection Shinya Yokoyama*, Hisao Nagato, Yuichi Yoshida, Shigeo Nagasaka, Kozo Kaneda and Noboru Nishiwaki
Abstract Background: Although repair of a supravalvular aortic stenosis (SVAS) can be performed with low mortality rates, surgery for the complex form of SVAS continues to be associated with a high incidence of residual stenosis. Case presentation: The patient was referred to our hospital at 1 month of age and was diagnosed with aortic valve stenosis (AS) by using echocardiography. Cardiac catheterization revealed moderate AS, and subsequent left ventriculography revealed discrete stenosis of the sino-tubular junction and a narrowed proximal ascending aorta. We performed a reconstructive operation for such heart defects involving novel three-sinus and ascending aorta enlargement without aortic root transection in a 6-month-old boy. Conclusion: Our novel three-sinus enlargement technique is suitable for treating each type of SVAS and is a useful method for a baby particularly less than 10 kg without disturbing the growth of the ascending aorta. Keyword: Supravalvular aortic stenosis, Aortic valve stenosis, Three-sinus enlargement, Infant
Background Although repair of a SVAS can be performed with low mortality rates, surgery for the complex form of SVAS, including repair of a diffuse narrow ascending aorta or single patch repair, continues to be associated with a high incidence of residual stenosis. Here, we report a case wherein successful novel three-sinus and ascending aorta enlargement was performed in an infant. The new procedure involves three-dimensional combination of three patches without aortic root transection. Case presentation The patient was a 6-month-old male infant (weight, 5.9 kg) diagnosed with aortic valve stenosis by echocardiography. Cardiac catheterization revealed moderate aortic valve stenosis due to thickened tricuspid valve, with left ventricular pressure of 143/- mmHg (end-diastolic pressure 11 mmHg) and an ascending aortic pressure of 83/38 mmHg (mean, 57 mmHg). Subsequent left ventriculography revealed discrete stenosis of the sino* Correspondence: [email protected] Department of Cardiovascular Surgery, Kinki University School of Medicine Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293, Japan
tubular junction and a narrowed proximal ascending aorta [Fig. 1]. The operation was performed at 6 months of age. After median sternotomy, a 30-mm square piece of autologous pericardium was harvested and treated with 0.6 % glutaraldehyde solution. Subsequent morphological inspection of the outer structure was performed, and features nearly identical to those at the preoperative diagnosis were noted. Cardiopulmonary bypass was established with ascending aortic and bicaval cannulations, aortic cross clamping was performed and cardiac arrest was achieved with cold crystalloid cardioplegia. First, an oblique incision was made on the anterior wall of ascending aorta. The pr
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