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J Cardiothorac Vasc Anesth. 2018 Feb;32(1):586-597. doi: 10.1053/j.jvca.2017.06.014. Epub 2017 Jun 7.

Aortic Regurgitation in Acute Type-A Aortic Dissection: A Clinical Classification for the Perioperative Echocardiographer in the Era of the Functional Aortic Annulus.

Author information

1
Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
2
Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
3
Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Duke University, Durham, NC.
4
Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: yiandoc@hotmail.com.

Abstract

The functional aortic annulus offers a clinical approach for the perioperative echocardiographer to classify the mechanisms of aortic regurgitation in acute type-A dissection. Comprehensive examination of the functional aortic annulus in this setting using transesophageal echocardiography can guide surgical therapy for the aortic root by considering the following important aspects: severity and mechanism of aortic regurgitation, extent of root dissection, and the pattern of coronary artery involvement. The final choice of surgical therapy also should take into account factors, such as patient presentation and surgical experience, to limit mortality and morbidity from this challenging acute aortic syndrome. This review explores these concepts in detail within the framework of the functional aortic annulus, detailed anatomic considerations, and the latest literature.

KEYWORDS:

3-dimensional imaging; Bentall procedure; David-V valve–sparing root replacement; acute type-A aortic dissection; aortic annulus; aortic cusp; aortic regurgitation; aortic valve resuspension; aortoventricular junction; coronary dissection; functional aortic annulus; intimal flap; mechanisms; sinotubular junction; sinus segment; transesophageal echocardiography; type I; type II; type III; type IV

Comment in

PMID:
28927697
DOI:
10.1053/j.jvca.2017.06.014
[Indexed for MEDLINE]

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