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Background The surgical ascending aorta repair according to the Cabrol procedure involves the interposition of a prosthetic conduit between the aortic prosthesis and the native coronary ostia. Previous cases of the Cabrol conduit stenosis have been described, most of which presented as acute coronary syndromes due to thrombotic occlusion of the graft. Case summary We present a case of stable exertional angina due to very-late stenosis of the coronary prosthetic conduit, successfully treated with trans-femoral percutaneous angioplasty and off-label implantation of a balloon-expandable bare-metal stent designed for peripheral artery disease. The multimodality imaging approach gave an essential contribution both to the assessment of the lesion and to the procedural planning. Despite the concerns about long-term results, a peripheral bare-metal stent was preferred over a standard coronary drug-eluting stent due to the remarkable dimension of the Cabrol conduit. Three years after the procedure, the patient is free from angina, and coronary computed tomography showed no significative luminal loss of the stent. Conclusion Elective angioplasty of a Cabrol graft requires a careful planning through a multimodality stenosis assessment. Conventional coronary stents can be not large enough to ensure adequate apposition to the wide prosthetic conduit and peripheral bare-metal stents may be taken into consideration, at the price of unknown long-term outcomes. [ABSTRACT FROM AUTHOR]

Giant Ascending Aorta Aneurysm (AAA) is a rare condition, because of early diagnosis incidence appears to be increasing as a result of routine screening, increased clinical awareness, and improved imaging modalities. The etiology of aneurysms involving the aortic root and ascending aorta can be genetically triggered, degenerative or atherosclerotic, inflammatory, or can result from infectious diseases. According to many studies for ascending aortic aneurysms larger than 6 cm the risk of rupture, dissection, or deaths was 15.6, making it a large life-threatening aneurysm. We present the case of a Giant AAA of about 8,7 cm diameter in a 68 years old man who was successfully operated on for ascending aorta and aortic root replacement under modified Bentall technique using composite mechanical conduit with coronary reimplantation. Conclusion; Ascending giant aortic aneurysm is a rare finding, varying from asymptomatic clinical presentation. Surgical treatment remains the standard treatment with very good results. The selection of the operating technique is very individual, depending on the case and the experience of the surgeon.

Aortic root abscess is the most severe sequela of infective endocarditis, and its surgical management is a complicated procedure because of the high risk of morbidity and death. Twenty-seven patients were included in this 15-year retrospective study: 21 (77.8%) with native- and 6 (22.2%) with prosthetic-valve endocarditis. The surgical reconstruction of the aortic root consisted of aortic valve replacement in 19 patients (70.4%) with (11) or without (8) a pericardial patch, or total aortic root replacement in 7 patients (25.9%); 5 of the 27 (18.5%) underwent the modified Bentall procedure with the flanged conduit. Only one patient (3.7%) underwent subaortic pericardial patch reconstruction without valve replacement. A total of 7 patients (25.9%) underwent reoperation: 6 with prior valve surgery, and 1 with prior isolated sinus of Valsalva repair. The mean follow-up period was 6.8 ± 3.7 years. There were 6 (22.2%) in-hospital deaths, 3 (11.1%) of which were perioperative, among patients who underwent emergent surgery. Five patients (23.8%) died during follow-up, and the overall survival rates at 1, 5, and 10 years were 70.3% ± 5.8%, 62.9% ± 6.4%, and 59.2% ± 7.2%, respectively. Two of 21 patients (9.5%) underwent reoperation because of paravalvular leakage and early recurrence of infection during follow-up. After complete resection of the perianular abscess, replacement of the aortic root can be implemented for reconstruction of the aortic root, with or without left ventricular outflow tract injuries. Replacing the aortic root with a flanged composite graft might provide the best anatomic fit. [ABSTRACT FROM AUTHOR]

We report the case of a 27-year-old woman with a rare presentation of right ventricular failure secondary to isolated right ventricular myocardial infarction, 3 weeks after an uncommon surgical procedure, the modified Cabrol operation. Her medical history also included a Ross procedure at the age of 12 years. On the basis of her subacute presentation and a consultation with cardiac surgeons, we decided on medical management. Follow-up echocardiography at 6 months revealed that the right ventricular systolic function remained severely impaired, but the patient was asymptomatic with excellent functional capacity. We review the surgical techniques of aortic graft replacement and their respective complications. We also discuss the impact of conservative and reperfusion strategies on prognosis and long-term outcomes in the setting of right ventricular infarction. [ABSTRACT FROM AUTHOR]

Background: Postoperative pseudoaneurysm of the aortic root is a difficult surgical problem and often a fatal complication of cardiac surgery. The diagnosis of iterative aortic dissection in Marfan Syndrome is critical for effective treatment. An aggressive surgical strategy such as Bentall technique, followed by life-long cardiovascular monitoring is used in order to save and prolong the survival of these patients. Objective: The goals of Bentall operation are to provide structural and functional restoration of the aortic root. Material and methods: We present the case of a 47-year-old woman diagnosed with Marfan Syndrome at 8 years old. She reached the Emergency Unit of the Emergency Clinical Hospital "Sf. Spiridon" Iaşi for retrosternal chest pain with abdominal irradiation, occurring at rest and accentuated in movement and dyspnea in low effort. She had suffered a surgical intervention for ascending aorta dissection and bicuspid aortic valve disease ten years beforehand. Results: Computed tomography revealed an aortic pseudoaneurysm located at the sinotubular junction accompanied by a periprosthetic hematoma. Chronic dissection was present all along the descending aorta, as well as dissection of the left subclavian. The patient successfully underwent repair of the ascending aortic pseudoaneurysm and concomitant aortic valve replacement using the modern Bentall procedure at the Institute for Cardiovascular Diseases. After medical and surgical treatment the patient's evolution was favorable. Conclusions: Aggressive aortic surgery with graft replacement in Marfan Syndrome determines these patients' survival in this kind of life threatening surgical emergency. The evolution of ascending aorta replacement techniques has substantially reduced the risk of sudden death and improved the quality of life of these patients. [ABSTRACT FROM AUTHOR]