The Annals of Thoracic Surgery, Vol 23, 499-506, Copyright © 1977 by The Society of Thoracic Surgeons
A new operation for far-advanced cystic medial necrosis of the aortic root
CS Weldon, TB Ferguson, PA Ludbrook and RC McKnight
Three patients with far-advanced cystic medial necrosis of the aorta, which
had produced giant bulbous enlargement of the aortic root and severe aortic
regurgitation, were operated on using a procedure not previously described.
Measurements of the aortic valve annulus and ascending aorta were made from
aortograms. A knitted polyester arterial prosthesis was sewn together to
form a circle. This circular prosthesis was sewn to a 31 mm Bjork-Shiley
aortic valve prosthesis in the way that a tire is fitted onto a wheel. The
resulting composite prosthesis, which had the same diameter as the aortic
root, was used to replace the excised valve. In all cases a composite
prosthesis measuring greater than 50 mm in diameter was used. In 2 of the 3
patients the ascending aorta was replaced with a tubular graft reshaped as
a truncated cone. This reshaping was done by inserting multiple gussets
into one end of the aortic prosthesis so that the flanged end fit precisely
to the transverse aortic arch. Two patients are asymptomatic more than two
years following operation. The third patient died suddenly of a ventricular
arrhythmia on the twenty-third postoperative day.
