[One-stage replacement of the entire thoracic aorta with aortic valve reimplantation technique--a reoperation for a Marfan patient with annulo-aortic ectasia and chronic aortic dissection of DeBakey type I].

Abstract

A 23-year-old man with Marfan syndrome, who had annulo-aortic ectasia and chronic aortic dissection of type I, was successfully treated. He underwent one-stage replacement of the entire thoracic aorta using a retrograde pull-through technique with aortic valve sparing reimplantation (David procedure). The descending aorta was replaced with a Hemashield graft, and then the graft was passed through within the descending aortic aneurysm in the retrograde fashion. Thus, the graft was inserted inside the descending aortic aneurysm without ligation of some of the intercostal arteries. Postoperative MRI showed complete clotting of the space between the graft and the aneurysm. David's reimplantation procedure which spares own aortic valve, requires no anticoagulant therapy in the post operative period. Neither aortic regurgitation nor pressure gradient between the left ventricle and the aorta were observed postoperatively. We conclude that the replacement of the entire thoracic aorta using a retrograde pull-through technique with an aortic valve sparing reimplantation by the single stage is useful for the selected patients with aneurysm of the entire thoracic aorta and annulo-aortic ectasia.