Usefulness of echocardiography in the long-term follow-up study after surgical treatment of annuloaortic ectasia.

From July, 1979 to August, 1987, 10 patients at our institution underwent a repair of annuloaortic ectasia (AAE), either with a separate aortic graft and valve or with Bentall's operation. There were no hospital deaths, although there were two late deaths from unrelated accidental causes. In nine of the patients, echocardiograms were recorded to evaluate the postoperative cardiac function and possible complications. M-mode echocardiography facilitated the evaluation of cardiac function, and two-dimensional echocardiography was better suited to studying the postoperative structures. On the other hand, the real time two-dimensional Doppler flow mapping ensured the diagnosis of dissecting aneurysms through the blood flow pattern. Although the postoperative hemodynamics improved significantly, pseudoaneurysms between the native aortic wall and the graft were detected in three patients, with compression to the composite conduit in one, and residual distal aortic dissection was noted in another three patients. It was thus concluded that the composite graft replacement of the ascending aorta and aortic valve in patients with AAE can be accomplished with a low risk, but pseudoaneurysm formation at the coronary ostial or aortic suture line may be observed late after surgery. Regular postoperative follow-up study is therefore of great importance, and echocardiography would be the most pertinent, non-invasive method of meeting this purpose.