Marfan's syndrome surgery: Difference between revisions
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'''Associate Editor-In-Chief:''' {{CZ}} ; {{CA}} | '''Associate Editor-In-Chief:''' {{CZ}} ; {{CA}} | ||
==Overview== | ==Overview== | ||
If the dilation of the aorta progresses to a significant diameter [[aneurysm]], causes a dissection or a rupture, or leads to failure of the aortic or other valve, then surgery (possibly a composite aortic valve graft [CAVG] or valve-sparing procedure) becomes necessary. | |||
==Surgery== | ==Surgery== | ||
Patients at high risk of aortic dissection may be counseled to undergo prophylactic aortic root replacement procedure. The 2010 ACC/AHA/AATS recommendations for indications for surgery include external diameter >50mm, rapid dilation (>5mm/year), a family history of aortic dissection at smaller diameters, the presence of aortic regurgitation, or extension of dilation beyond the sinuses of valsalva <ref name="pmid20351702">{{cite journal |author=Cañadas V, Vilacosta I, Bruna I, Fuster V |title=Marfan syndrome. Part 2: treatment and management of patients |journal=[[Nature Reviews. Cardiology]] |volume=7 |issue=5 |pages=266–76 |year=2010 |month=May |pmid=20351702 |doi=10.1038/nrcardio.2010.31 |url=http://dx.doi.org/10.1038/nrcardio.2010.31 |issn= |accessdate=2010-12-22}}</ref>, <ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=20233780 |issn= |accessdate=2010-12-22}}</ref>. The gold standard surgical intervention remains the technique described by Bentall and De Bono in 1968. The aortic root and valve are replaced with a composite Dacron graft and artificial valve. Patients treated with this procedure must take anticoagulants for the remainder of their lives. More recently, two valve-sparing procedures have been practiced: the aortic root remodeling procedure and the aortic valve reimplantation procedure. In the remodeling procedure, a graft is created containing three neosinuses and sutured slightly superior to the native valve. The reimplantation procedure reimplants the native valve into the Dakon graft and is thought to prevent future dilation, but is more technically demanding. | Patients at high risk of aortic dissection may be counseled to undergo prophylactic aortic root replacement procedure. The 2010 ACC/AHA/AATS recommendations for indications for surgery include external diameter >50mm, rapid dilation (>5mm/year), a family history of aortic dissection at smaller diameters, the presence of aortic regurgitation, or extension of dilation beyond the sinuses of valsalva <ref name="pmid20351702">{{cite journal |author=Cañadas V, Vilacosta I, Bruna I, Fuster V |title=Marfan syndrome. Part 2: treatment and management of patients |journal=[[Nature Reviews. Cardiology]] |volume=7 |issue=5 |pages=266–76 |year=2010 |month=May |pmid=20351702 |doi=10.1038/nrcardio.2010.31 |url=http://dx.doi.org/10.1038/nrcardio.2010.31 |issn= |accessdate=2010-12-22}}</ref>, <ref name="pmid20233780">{{cite journal |author=Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=[[Circulation]] |volume=121 |issue=13 |pages=e266–369 |year=2010 |month=April |pmid=20233780 |doi=10.1161/CIR.0b013e3181d4739e |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=20233780 |issn= |accessdate=2010-12-22}}</ref>. The gold standard surgical intervention remains the technique described by Bentall and De Bono in 1968. The aortic root and valve are replaced with a composite Dacron graft and artificial valve. Patients treated with this procedure must take anticoagulants for the remainder of their lives. More recently, two valve-sparing procedures have been practiced: the aortic root remodeling procedure and the aortic valve reimplantation procedure. In the remodeling procedure, a graft is created containing three neosinuses and sutured slightly superior to the native valve. The reimplantation procedure reimplants the native valve into the Dakon graft and is thought to prevent future dilation, but is more technically demanding. | ||
Revision as of 15:36, 22 August 2012
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Marfan's syndrome Microchapters | |
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Marfan's syndrome surgery On the Web | |
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Risk calculators and risk factors for Marfan's syndrome surgery | |
Editors-In-Chief: William James Gibson, C. Michael Gibson, M.S., M.D.
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1] ; Assistant Editor-In-Chief: Cassandra Abueg, M.P.H. [2]
Overview
If the dilation of the aorta progresses to a significant diameter aneurysm, causes a dissection or a rupture, or leads to failure of the aortic or other valve, then surgery (possibly a composite aortic valve graft [CAVG] or valve-sparing procedure) becomes necessary.
Surgery
Patients at high risk of aortic dissection may be counseled to undergo prophylactic aortic root replacement procedure. The 2010 ACC/AHA/AATS recommendations for indications for surgery include external diameter >50mm, rapid dilation (>5mm/year), a family history of aortic dissection at smaller diameters, the presence of aortic regurgitation, or extension of dilation beyond the sinuses of valsalva [1], [2]. The gold standard surgical intervention remains the technique described by Bentall and De Bono in 1968. The aortic root and valve are replaced with a composite Dacron graft and artificial valve. Patients treated with this procedure must take anticoagulants for the remainder of their lives. More recently, two valve-sparing procedures have been practiced: the aortic root remodeling procedure and the aortic valve reimplantation procedure. In the remodeling procedure, a graft is created containing three neosinuses and sutured slightly superior to the native valve. The reimplantation procedure reimplants the native valve into the Dakon graft and is thought to prevent future dilation, but is more technically demanding.
References
- ↑ Cañadas V, Vilacosta I, Bruna I, Fuster V (2010). "Marfan syndrome. Part 2: treatment and management of patients". Nature Reviews. Cardiology. 7 (5): 266–76. doi:10.1038/nrcardio.2010.31. PMID 20351702. Retrieved 2010-12-22. Unknown parameter
|month=ignored (help) - ↑ Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780. Retrieved 2010-12-22. Unknown parameter
|month=ignored (help)