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April 1966

Aneurysm of the Ascending Aorta With Aortic Valvular InsufficiencySurgical Management

Author Affiliations

From the Cora and Webb Mading Department of Surgery, Baylor University College of Medicine, and the Cardiovascular Service, St. Luke's Episcopal and Texas Children's Hospitals, Houston.

Arch Surg. 1966;92(4):588-599. doi:10.1001/archsurg.1966.01320220144023

ANEURYSM of the ascending aorta associated with aortic valve incompetence is a formidable pathologic entity. Progressive expansion of the aneurysm may result in both aortic dissection or rupture with fatal hemorrhage and increasing aortic valvular regurgitation.1 Effective surgical therapy would relieve cardiac failure and chest pain due to valvular incompetence or compromised coronary artery perfusion and should prevent fatal consequences.

The entire ascending thoracic aorta is often involved in the degenerative process which may extend into the aortic arch (Fig 1). In some cases the dilatation is confined to the proximal ascending aorta producing a "Florence flask" deformity. Accompanying annular dilatation, as in the cases with annuloaortic ectasia and cystic medial necrosis,2,3 will result in aortic valvular regurgitation without pathologic changes in the aortic leaflets.

Successful surgical management includes both correction of the aortic valvular insufficiency and excision of the aneurysm with restoration of aortic continuity. This has

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