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• W2029805937 abstract "HomeCirculationVol. 115, No. 7Apicoaortic Double-Valved Conduit in a 40-Year-Old Woman Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBApicoaortic Double-Valved Conduit in a 40-Year-Old Woman Sanjay Sarin, Anwer Qureshi and Jamshid Shirani Sanjay SarinSanjay Sarin From the Department of Cardiology, Geisinger Medical Center, Danville, Pa. Search for more papers by this author , Anwer QureshiAnwer Qureshi From the Department of Cardiology, Geisinger Medical Center, Danville, Pa. Search for more papers by this author and Jamshid ShiraniJamshid Shirani From the Department of Cardiology, Geisinger Medical Center, Danville, Pa. Search for more papers by this author Originally published20 Feb 2007https://doi.org/10.1161/CIRCULATIONAHA.106.654632Circulation. 2007;115:e197–e199A 40-year-old woman was admitted with pneumonia and septic shock. Chest x-ray showed bilateral pulmonary infiltrates, cardiomegaly, and a bioprosthetic valve in an unusual position near the left ventricular apex (Figure 1A). The patient had a history of muscular subaortic stenosis. At age 4, she underwent surgical resection, but severe subaortic stenosis recurred 5 years later when an apicoaortic conduit containing an Ionescu–Shiley bioprosthetic valve was placed between the left ventricular apex and the descending thoracic aorta. Six years later, a 22-mm St. Jude mechanical prosthesis was also inserted within the apicoaortic conduit, distal to the malfunctioning (regurgitant) Ionescu–Shiley prosthesis. Download figureDownload PowerPointFigure 1. A, Chest roentgenogram in anteroposterior view showing cardiomegaly and bilateral pulmonary infiltrates. The Ionescu–Shiley pericardial bioprosthesis (1) is identified by a radiopaque valve ring at the left lateral border of the heart. B and C, Cross-sectional computerized tomographic view of the heart showing the apicoaortic conduit (*) containing the Ionescu–Shiley pericardial bioprosthesis (1) proximal to a St. Jude mechanical prosthesis (2). AO indicates aorta (descending); LV, left ventricle.Transesophageal echocardiography showed a patent conduit containing a normally functioning St. Jude prosthesis, with no evidence of endocarditis (Figure 2). A cardiac computed tomography scan clearly showed the proximally placed Ionescu–Shiley and distally placed St. Jude prostheses (Figure 1B and 1C). Download figureDownload PowerPointFigure 2. Transesophageal echocardiographic views of the heart and aorta. A, Origin of the conduit at the left ventricular (LV) apex (*) (Movie I). B, Flow acceleration at the LV apex in systole by color flow Doppler (Movie II). C, Distal insertion of the conduit (*) into descending thoracic aorta (AO) (Movie III). The St. Jude mechanical prosthesis (2) has produced intense acoustic signal. D, Systolic flow through the apicoaortic conduit into the descending thoracic aorta by color flow Doppler (Movie IV).Apicoaortic valved conduit (or aortic valve bypass) surgery has been used to create alternative left ventricular outflow in patients with complex pathology, small aortic annulus, calcified or porcelain aorta, multiple prior sternotomies, or como-bidities. The conduit connects the left ventricular apex to the descending thoracic aorta through left thoracotomy, without the need for cardiopulmonary bypass. Single-center experience with this type of surgery has been limited.1,2 To our knowledge, no patient with a double-valved apicoaortic conduit has been reported before.The online-only Data Supplement, consisting of Movies I through IV, is available with this article at http://circ.ahajournals.org/cgi/content/full/115/7/e197/DC1.DisclosuresNone.FootnotesCorrespondence to Sanjay Sarin, MD, Geisinger Medical Center, 100 North Academy Ave, Danville, PA 17822–2160. E-mail [email protected]References1 Renzulli A, Gregorio R, De Feo M, Ismeno G, Covino FE, Cotrufo M. Long-term results of apico-aortic valved conduit. Tex Heart Inst J. 2000; 27: 24–28.MedlineGoogle Scholar2 Cooley DA, Lopez RM, Absi TS. Apicoaortic conduit for left ventricular outflow tract obstruction: revisited. Ann Thorac Surg. 2000; 69: 1511–1514.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Nance J, Barraza J, Henzler T, McMaster W, Kratz J and Schoepf U (2012) Apicoaortic Conduits, Journal of Thoracic Imaging, 10.1097/RTI.0b013e31820e4701, 27:3, (141-147), Online publication date: 1-May-2012. February 20, 2007Vol 115, Issue 7 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.654632PMID: 17309922 Originally publishedFebruary 20, 2007 PDF download Advertisement SubjectsCardiovascular SurgeryComputerized Tomography (CT)EchocardiographyValvular Heart Disease" @default.
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