Bentall Procedure / Arotic root Surgery – Case Study and Certain Essentials

By Dr. Vishal Dhir in Cardiology

Sep 17, 2020

Aorta is the largest artery carrying oxygenated blood from the heart to all parts of the body. Sometimes the aorta gets enlarged due to the weakness of the artery wall which leads to a condition known as ‘ANEURYSM’

An aneurysm can develop in any part of the aorta. an aneurysm that occurs in the aorta located in the chest area is called ‘ THORACIC AORTIC ANEURYSM’

In aortic valve and root replacement (composite aortic root replacement), your surgeon removes a section of your aorta and your aortic valve. The section of your aorta is replaced with an artificial tube (graft), and your aortic valve is replaced with a mechanical or biological valve. If you have a mechanical valve, you’ll need to take anticoagulant medications for life to prevent blood clots.

Symptoms

• Most of the aneurysm are asymptomatic and detected on the screening
• Some patients may present with chest pain, back pain, pain in the neck & Jaws.
• Patients may complain of cough & hoarseness of voice
• Breathing difficulty

Risk Factor

• Family History – Connective tissue disorder
• Smoking
• High Blood Pressure
• Diabetic Mellitus
• Heart disease
• High Cholesterol
• Relatives of these patients should be screened for aorta aneurysm.

How to diagnose an aortic aneurysm

ECHO Cardiography – Screening investigation for aorta aneurysm

CT- Angiography

• To see the extent of the aneurysm
• To plan of treatment

Which aorta aneurysm need treatment

• Aortic Aneurysm > 5.5 cm in size
• Aortic Aneurysm > 5.0 cm size in patients with connective tissue disorders
• Associated Valvular dysfunction

Why aortic aneurysm need treatment

• May Rupture – As there is weakening in asteroid walls so there is a higher incidence of rupture & leads to profuse bleeding & death
• Pressure Symptoms – A large aneurysm may press the surrounding Fracture
• Dissection – Wall may rupture partially and blood may seep into the artend wall & may compress the lumen of the Aorta …..Leading to multi-system organ failure
• Heart Failure – When associated with Valvular dysfunction may lead to symptoms of conjecture heart failure.

Treatment Modalities

• Open surgical Treatment – Aneurysm wall excised & replaced with a synthetic graft.
• Endo Vascular treatment- covered start graft

Case Report

Patient Net Ram 61yr admitted to Metro Hospital, palamvihar in august 2020 with symptoms of chest pain & breathlessness.On evaluation by echocardiography, the patient was found to be having severe aortic regurgitation & aneurysmal dilatation of the ascending aorta.

CT angiography was done which moved aneurysmal dilatation of the ascending aorta ( Maximum Diameter = 6.5 cm ) coronary angiography was done which showed significant disease in the left circumflex artery. The patient was planned for valve replacements ascending aortic aneurysm repair & coronary artery bypass grafting. The patient was operated for Bentall procedure which included replacement of the aortic valve & ascending aorta with composite valved conduct. Also, coronary artery bypass grafting was done. The patient made an uneventful & smooth post-operative course and discharged from the hospital in a stable condition.