The individual procedure performed depended on the local anatomy and the presence of acute dissection or aneurysmal dilatation which determined the quality of tissues for reconstructive anastomoses.
One patient in this group had repair of the dissection by graft interposition only. This patient had a localized tear with preservation of the aortic valve. He had placement of a size 34 intraluminal stent which was tied down over both ends of the aortic dissection in the ascending aorta. This patient had significant coagulopathy and underwent reexploration for tamponade but had no other significant perioperative complications.
FIGURE 1. Composite aortic valve conduit, Bjork-Shiley model AGV.
The nine other patients underwent placement of a mechanical valved conduit to reconstruct the aortic valve and ascending aorta (Bjork-Shiley model AGV) (Fig 1). In all cases the valve conduit was placed into the aortic anulus after excision of the incompetent aortic valve. Interrupted sutures were used. The coronary ostia were anastomosed to the sides of the conduit graft. A small disc of graft was excised next to the coronary artery ostium and the two were approximately half the patients had significant coagulopathy and three required return to the operating room for reexploration after accumulation or drainage of excessive blood. Several days postoperatively, patients with the mechanical Bjork-Shiley valve began receiving a heparin drip and then subsequently received the anticoagulant warfarin. One patient required late drainage of bloody pericardial fluid, but no other wound complications were apparent from the institution of anticoagulation. Patients were maintained indefinitely on oral medication with a prothrombin time one and a half to two times control values.
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Magnetic resonance images in the transverse, coronal, sagittal and sagittal-oblique planes were obtained on a superconducting MR system (G.E.-Signa) operating at 1.5 Tesla (T) (64mHz). All images were spin echo images cardiac gated to the R wave of a transmitted ECG signal. The repetition time (TR) was determined by the patients heart rate and the echo time (ТЕ) was 20 and 40 ms (symmetrical echos were performed to help differentiate abnormal blood flow from thrombosis). The section thickness varied between 5 and 10 mm, with 2.5- or 5-mm gaps. Using a matrix size of 256 X 128 pixels, in-plane resolution varied from 1.25 to 3.10 mms.