DOI: http://dx.doi.org/10.18203/2349-2902.isj20212319

David procedure for aortic root aneurysm in the background of Marfan syndrome patient with severe kyphoscoliosis and previous mitral valve replacement

Mohd Faizal Effendi Zulkifli, Muhamad Azri Muhamad Marican, Mohamad Arif Muhammad Nor, Abdul Muiz Jasid, Mohd Hamzah Kamarulzaman

Abstract


Cardiac complication is one of the diseases that usually develop in Marfan syndrome patient such as mitral valve regurgitation and aortic root aneurysm. Apart from that, other congenital anomalies also tend to occur in this group of patients such as pectus excavatum and scoliosis. We report a case of successful high-risk surgery involving a Marfan syndrome patient who had underlying severe kyphoscoliosis and previous mitral valve replacement that underwent redo sternotomy and valve sparing aortic root repair (David procedure). The surgery was challenging due to the need to perform redo-sternotomy on severe pectus patient, performing valve sparing aortic root repair, and complicated with injury to right coronary artery require modified Cabrol modification for implantation of the coronary artery. The available literature about redo sternotomy on severe pectus excavatum for aortic root repair is limited, hence this paper aims to highlight the successful of performing the procedure, and the complication that might occur during the procedure.


Keywords


Aneurysm, Aorta, Marfan, Pectus, Redo-sternotomy, Cabrol

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References


Judge DP, Dietz HC. Marfan's syndrome. Lancet. 2005;366(9501):1965-76.

Finkbohner R, Johnston D, Crawford ES, Coselli J, Milewicz DM. Marfan syndrome. Long-term survival and complications after aortic aneurysm repair. Circulation. 1995;91(3):728-33.

David TE, David CM, Manlhiot C, Colman J, Crean AM, Bradley T. Outcomes of Aortic Valve-Sparing Operations in Marfan Syndrome. J Am Coll Cardiol. 2015;66(13):1445-53.

Burgstaller JM, Held U, Mosbahi S, Stak D, Steurer J, Eckstein F, Berdajs DA. A systemic review and meta-analysis: long-term results of the Bentall versus the David procedure in patients with Marfan syndrome. Eur J Cardiothorac Surg. 2018;54(3):411-9.

Kourliouros A, Soni M, Rasoli S, Grapsa J, Nihoyannopoulos P, Regan D, et al. Evolution and current applications of the Cabrol procedure and its modifications. Ann Thorac Surg. 2011;91(5):1636-41.

Jondeau G, Detaint D, Tubach F, Arnoult F, Milleron O, Raoux F, et al. Aortic event rate in the Marfan population: a cohort study. Circulation. 2012;125(2):226-32.

Hartog AW, Franken R, Zwinderman AH, Timmermans J, Scholte AJ, Berg MP, et al. The risk for type B aortic dissection in Marfan syndrome. J Am Coll Cardiol. 2015;65(3):246-54.

Gott VL, Cameron DE, Alejo DE, Greene PS, Shake JG, Caparrelli DJ, et al. Aortic root replacement in 271 Marfan patients: a 24-year experience. Ann Thorac Surg. 2002;73(2):438-43.

Une D, Ruel M, David TE. Twenty-year durability of the aortic Hancock II bioprosthesis in young patients: is it durable enough?. Eur J Cardiothorac Surg. 2014;46(5):825-30.

Leshnower BG, Myung RJ, Pherson L, Chen EP. Midterm results of David V valve-sparing aortic root replacement in acute type A aortic dissection. Ann Thorac Surg. 2015;99(3):795-800.

Leontyev S, Schamberger L, Davierwala PM, Aspern VK, Etz C, Lehmann S, Misfeld M, et al. Early and Late Results After David vs Bentall Procedure: A Propensity Matched Analysis. Ann Thorac Surg. 2020;110(1):120-6.