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Eur J Cardiothorac Surg 2007;32:684. doi:10.1016/j.ejcts.2007.06.020
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Letters to the Editor |
Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University, Duesseldorf, Germany
Received 19 June 2007; accepted 19 June 2007.
* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Moorenstrasse 5, D-40225 Duesseldorf, Germany. Tel.: +49 211 8118331; fax: +49 211 8188333. (Email: litmathe{at}med.uni-duesseldorf.de).
Key Words: Aortic surgery • External reinforcement • Ectasia • Aortic valve stenosis • Aortic valve insufficiency
We thank Dr Apostolakis sincerely for his letter and the interest to share his own experience in this interesting topic [1].
As already pointed out in the underlying original work [2], and in agreement with the overwhelming majority of further authors [3–5], reduction aortoplasty is an accepted procedure for aortic dilatation in cases of absence of circumscribed aneurysm and without connective tissue disease, such as Marfan or Ehlers-Danlos syndrome. Of course, the most common basic disease of this feature is a poststenotic dilatation on the base of severe aortic stenosis or combined aortic valve disease. In cases of isolated aortic valve insufficiency, the quality of the aortic wall is judged by the surgeon when deciding for either replacement or reduction aortoplasty. Such approach was, by the way, justified afterwards because in our cohort no patient suffered from connective tissue disease as proven by subsequent histological examination.
Apostolakis then states that the sinuses of Valsalva are not included either by reinforcement or by reduction aortoplasty and, thus, may undergo dilatation or dissection: in absence of connective tissue disease, the sinuses are usually not included in dilatation of the aortic root and, thus, are not the aim of reconstruction as in procedures according to David or Yacoub. Such pathologic morphology is addressed by Marfan or Ehlers-Danlos syndrome in which cases reduction aortoplasty is strongly prohibited.
In our cohort no case of affection of coronary ostia occurred as assumed by Apostolakis. If there had been any clue for myocardial ischemia angiography, then revascularization would have been carried out immediately.
The follow-up period (<72 months) has been mentioned as being too small. We do not think that 6 years is too little. However, the investigation is in progress and we will possibly report the latest results soon.
Finally, Apostolakis states that external reinforcement is useless because under subtraction of the pathologic jet, re-dilatation should not be expected: if physiologic blood stream was able to prevent dilatation in those cases, even reduction aortoplasty would not be really useful in our opinion as this can easily be achieved by isolated aortic valve replacement. Weighing all arguments, we think that reduction aortoplasty with external reinforcement is a proven method with satisfactory long-term results seeing the individual anamnesis and pathologic morphology of every single patient.
References
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