CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC_11(10-11)_50610.15836/ccar2016.506Extended AbstractComplex case of aortic disease with some extras (AVR, MVrep, TVrep, Carotidosubclavian bypass)http://orcid.org/0000-0002-7735-6721RudežIgorhttp://orcid.org/0000-0001-6602-699XVarvodićJosiphttp://orcid.org/0000-0001-5955-0275BarićDavorhttp://orcid.org/0000-0003-2740-4067UnićDanielhttp://orcid.org/0000-0001-7125-361XBlažekovićRoberthttp://orcid.org/0000-0002-9833-832XPlanincMislavhttp://orcid.org/0000-0001-5690-9924KušurinMarkohttp://orcid.org/0000-0003-2478-9192MarkinMichaelhttp://orcid.org/0000-0002-4304-1852GjorgjievskaSavicahttp://orcid.org/0000-0001-6926-9436SutlićŽeljkoUniversity Hospital Dubrava, Zagreb, CroatiaAddress for correspondence: Josip Varvodić, Klinička bolnica Dubrava, HR-10000 Zagreb, Croatia. / Phone: +385-99-3553-909 / E-mail: josip.varvodic@gmail.com1120161110-1150650623092016101020162016Croatian Cardiac SocietyKeywords: E-vitaaortic aneurysm
Introduction: Extensive aortic pathology with concomitant valvular disease is a challenge for the surgeon. Careful and detailed planning of procedures and thorough preoperative diagnostics are essential for the outcome. (1, 2)
Case report: We present a case of a 45-year-old male who is under cardiologist control since early childhood and was operated due to aortic coarctation at the age of nine. He presented to the emergency room with chronic heart failure symptoms. MSCT angiography showed aneurysm of descending aorta 88mm x 85mm and stenosis of the arch proximal to the left subclavian artery up to 22 mm. Transthoracic/transoesophageal echocardiography revealed EF 40%, LA 5.1 cm, LVd 6.2 cm, LVs 5 cm, aortic valve bicuspid, sclerotic PPG 41 mmHg, MPG 29 mmHg, area 1.2 cm2 AR 2+, MR 3+ VC 6mm, TR trace. Elective surgery was planned. Under direct visualization a size 24 E-vita open plus stent graft (JOTEC GmbH, Germany, Hechingen) was deployed, aortic arch was replaced with the vascular part of the E-vita open plus, and supraaortic branches were reimplanted using the island technique in circulatory arrest (55 min) with bilateral antegrade cerebral perfusion and moderate hypothermia (28°C). Aortic valve replacement (Carbomedics Mechanical 21), mitral valve repair (Carpentier Edwards Physio II ring 30 mm), tricuspid valve repair (Edwards MC3 Tricuspid Annuloplasty System 30 mm) were done respectively. Left carotido-subclavian bypass was performed to ensure better landing zone for the Evita open plus stent graft (zone II).
The patient recovered well from surgery and postoperative ECHO has shown normal function of valves with perfect position of the stent graft with complete exclusion of the aneurysm from circulation. The patient was discharged home seven days after surgery, and was without complications after three months follow up.
Conclusion: Detailed planning of extensive cardiac surgery procedure can predict successful outcome.
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