Key result
Partial root remodeling with total arch replacement completely resolves aortic regurgitation in type A dissection.
Why the study?
Valve-sparing aortic root reconstruction using the partial remodeling technique requires technical proficiency and its outcomes in type A aortic dissection cases need further reporting.
Case Report (n=1)
No
Partial remodeling is a viable and effective technique for valve-sparing aortic root reconstruction in patients with Stanford type A aortic dissection involving the aortic root.
Supports feasibility of partial root remodeling in acute type A dissection with AR; leaves open durability and generalizability.
48歳女性．2カ月前からの労作時呼吸困難と両側下腿浮腫を主訴に来院し，心臓超音波検査にてバルサルバ洞の拡大，大動脈弁逆流，弁尖直上のflapを認め，心臓同期造影CTにて弁尖直上から両側総腸骨動脈分岐部までのStanford A型大動脈解離を認めた．右冠動脈は偽腔から分岐し，右冠尖と無冠尖の交連部が解離していた．左冠動脈は真腔から分岐していた．心不全加療後，partial remodeling法による自己弁温存基部再建術と上行弓部大動脈人工血管置換術，右冠動脈バイパス術を施行した．手術時間は402分，人工心肺時間が234分，大動脈遮断時間167分，選択的脳灌流時間は109分で手術を終了し，術後経過良好で術後12病日に合併症なく独歩退院となった．術後，大動脈弁は形態に問題なく，逆流は良好に制御された．自己弁温存基部再建術は技術的習熟を要するが，本症例ではpartial remodelingを施行し，良好な成績を得たため報告する．
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Furuichi et al. (2020) conducted a case report in Stanford type A aortic dissection (n=1). Valve sparing partial root remodeling, right coronary artery bypass and total arch replacement was evaluated on Postoperative course and aortic regurgitation resolution. Valve sparing partial root remodeling combined with total arch replacement successfully treated a 48-year-old woman with Stanford type A aortic dissection, completely resolving aortic regurgitation.
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