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Date Published: 19/04/2023
Abstract Views: 1061
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DOI: https://doi.org/10.47972/vjcts.v41i.867
Issue
Vol. 41
Section
Research Article
How to Cite
Vu Ngoc, T. (2023). Surgical treatment of bicuspid aortic valve with aortic stenosis. The Vietnam Journal of Cardiovascular and Thoracic Surgery, 41, 54-63. https://doi.org/10.47972/vjcts.v41i.867

Surgical treatment of bicuspid aortic valve with aortic stenosis

Tu Vu Ngoc

Main Article Content

Abstract

Background: Patients with bicuspid aortic valve may develop isolated aortic valve disease, including isolated aortic stenosis. This disease progresses over a long period of time leading to simultaneous damage of the valves and aorta. Surgery is an effective treatment of both lesions simultaneously. This study objective is to describe the characteristic features of the diagnosis and surgery results of this disease.


Methods: All of patients diagnosed aortic stenosis due to bicuspid aortic valve were performed aortic valve replacement and asscociated aortic lesions. This retrospective descritptive study used data from the Hanoi Medical Uninversity Hospital from 3/2020 to 3/2023.


Results: This study include 25 patients who met review criteria. Aortic stenosis was in all of patients associated with ascending aortic aneurysm. Mean aortic gradient was 56,7mmHg and 36,0% of patients had ascending aortic diameter above 45mm. The most common morphology of bicuspid aortic valve was right – left coronary leaflet. 8,0% of patients had poor left ventricle function (EF < 30%). 36,0% of patients were perfomed single aortic valve replacement, 60,0% were corrected simultaneously lesions of aortic valve and ascending aorta in which 24,0% using wrapping with dacron graft. Complications: One death due to intraoperative Stanford A aortic dissection; one bleeding due to lateral wound close distal aortic anastomosis required an operation and one of sternal instability require a sternal plasty. 96,0% of patients have discharged uneventfully.


Conclusions: Surgery is an effective treatment of both lesions simultaneously of aortic valve and descending aorta in aortic stenosis due to bicuspid aortic valve malformation. Wrapping of the ascending aorta may be useful in patients who need to undergo aortic valve surgery without increasing the risk of surgery.

Article Details

Keywords

bicuspid aortic valve malformation, aortic stenosis, calcified aortic valve, ascending aortic aneurysm, aortic valve replacement, ascending aorta replacement

References

1. Masri A, Svensson LG, Griffin BP, Desai MY. Contemporary natural history of bicuspid aortic valve disease: a systematic review. Heart. 2017;103(17):1323-30.
2. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72-e227.
3. Phạm Mạnh Hùng, Đinh Huỳnh Linh. Cập nhật về chỉ định thay van động mạch chủ qua đường ống thông. Tim mạch học Việt Nam. 2019;90:40-6.
4. Ngô Thành Hưng, Nguyễn Công Hựu, Nguyễn Trần Thủy, Nguyễn Hoàng Nam, Phạm Thành Đạt, Lê Ngọc Thành, et al. Kết quả sớm phẫu thuật tái tạo van động mạch chủ hai lá van bằng màng ngoài tim tự thân. Tạp chí Nghiên cứu Y học. 2021;137(1):125-34.
5. Sievers H-H, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. The Journal of Thoracic and Cardiovascular Surgery. 2007;133(5):1226-33.
6. Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller G-P, et al. 2020 ESC Guidelines for the management of adult congenital heart disease: The Task Force for the management of adult congenital heart disease of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Adult Congenital Heart Disease (ISACHD). European Heart Journal. 2021;42(6):563-645.
7. Braverman AC, Güven H, Beardslee MA, Makan M, Kates AM, Moon MR. The bicuspid aortic valve. Current problems in cardiology. 2005;30(9):470-522.
8. Kravchenko I, Kravchenko V, Sytar L, Pantas O, Dykuha S, Atamanyuk M, et al. Surgical treatment of bicuspid aortic valve disease. Journal of Cardiothoracic Surgery. 2013;8(S1):P7.
9. Phạm Mạnh Hùng, Nguyễn Lân Hiếu, Nguyễn Ngọc Quang, Đinh Huỳnh Linh, Tạ Mạnh Cường, Nguyễn Thị Thu Hoài, et al. Đánh giá hiệu quả sớm của kĩ thuật thay van động mạch chủ qua đường ống thông để điều trị bệnh nhân hẹp khít van động mạch chủ. Tạp chí Tim mạch học Việt Nam. 2016;74:17-24.
10. Erdogan HB, Kayalar N, Ardal H, Omeroglu SN, Kirali K, Guler M, et al. Risk Factors for Requirement of Permanent Pacemaker Implantation After Aortic Valve Replacement. Journal of Cardiac Surgery. 2006;21(3):211-5.
11. González-Santos JM, Arnáiz-García ME. Wrapping of the ascending aorta revisited—is there any role left for conservative treatment of ascending aortic aneurysm? Journal of thoracic disease. 2017;9(Suppl 6):S488.
12. El Gamel A. Ascending Aortic Aneurysm Wrapping: The Renaissance of an Old Technique. Heart, Lung and Circulation. 2019;28(12):1770-2.
13. Flecka T, Ehrlicha M, Czernya M, Wolnera E, Grabenwogerb M, Grimma M. Intraoperative iatrogenic type A aortic dissection and perioperative outcome. (1569-9285).
14. Losenno KL, Goodman RL, Chu MWA. Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge. Cardiology Research and Practice. 2012;2012:1-16.