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
BLOODWELL RD, HALLMAN GL, COOLEY DA. Aneurysm of the Ascending Aorta With Aortic Valvular Insufficiency: Surgical Management. Arch Surg. 1966;92(4):588–599. doi:10.1001/archsurg.1966.01320220144023
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