title: Asymmetric medial degeneration of the ascending aorta in aortic valve disease: a pilot study of surgical management.
abstract: OBJECTIVE
  In structural aortic valve disease, medial degeneration is often associated with ascending aorta dilatation. This pathology is often asymmetric, with more severe involvement of the convex aspect of the ascending aorta. The condition can be managed with surgical excision of the diseased portion of the aortic wall and remodeling reconstruction at the time of aortic valve replacement (AVR).
  
  
  METHODS
  Sixty-one patients underwent AVR and 'waistcoat aortoplasty'. Sinus dilatation was repaired by plicating the subcoronary redundant aortic wall using anchoring sutures of the valve prosthesis. The diseased aortic wall was removed via a triangular resection, and the aorta reconstructed with a double-layer technique, to achieve autologous reinforcement of the convex right posterolateral wall and stress reduction on the aortotomy suture line. Echocardiography was performed preoperatively, immediately postoperatively, and every six months thereafter. The significance of diameter variations was evaluated.
  
  
  RESULTS
  There was no hospital mortality, and only low postoperative morbidity. Post-reduction diameters at the sinuses, sinotubular junction and ascending aorta were significantly less than preoperative values (p < 0.0001). During a mean follow up of 33.8 +/- 10.2 months (range: 13-50 months), no significant increase in root (p = 0.32), sinotubular (p = 0.15), or ascending diameter (p = 0.11) was observed.
  
  
  CONCLUSIONS
  The 'waistcoat aortoplasty' should be considered when dealing with asymmetric ascending dilation secondary to aortic valve disease-related medial degeneration. However, additional studies with a longer follow up are needed to confirm these findings.
authors.affiliation: Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, V. Monaldi Hospital, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cotrufo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Corte
authors.forename: Luca S
authors.initials: LS
authors.lastname: De Santo
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.forename: Franco E
authors.initials: FE
authors.lastname: Covino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dialetto
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D012008:Recurrence; D012720:Severity of Illness Index; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome