recently valve replacement has been the only surgical option for AI. However, none of the current valve substitute is ideal options, until the mechanical valves are requiring life-long anticoagulation &bioprosthetic valve, present the risk of re-operation. Over the past 20years valve preserving Aortic root replacement has evolved into an increasing accepted alternative to composite replacement of aorta& valve. Preservation of the native valve has the obvious advantage of obviating the need for anticoagulation& its related complications. Two basic different principle of valve preserving Aortic replacement are currently used, & minor modifications have been proposed for both. The Aortic valve sparing reimplantation technique, first described by David et al, in 1992, was originally developed as an Aortic valve sparing operation for patients with Aortic valve incompetence and aneurysm for ascending aorta. Remodeling of the root was originally designed by Yacoub, & it has been demonstrated to restore root geometry and improve Aortic valve competence. At Razavi Hospital (Mashhad), valve sparing Aortic root replacement is the operation of choice for any suitable patient presenting with an aneurysm of the ascending aorta, dissection of the aorta type A, Bycuspid or Marfan syndrome& Aortic valve insufficiency. In our experience, valve sparing either of the Yacoub or David type can be performed safety in acute and elective

For patients with a small aorta, surgeons may use techniques such as the Manouguian method in addition to Aortic valve replacement (AVR) to prevent patient prosthetic mismatch. These methods have been shown to have good outcomes and few complications. However, in this case presentation, a rare complication occurred in a 47-year-old woman who underwent AVR plus Manouguian surgery. After the surgery, her echocardiography revealed iatrogenic supra-Aortic stenosis. The diagnosis was confirmed with computed tomography angiography, and the patient underwent surgery again at the site of the stenosis. Fortunately, the surgery was successful, and the stenosis was completely resolved.

Concomitant replacement of the ascending aorta and heart transplantation are an infrequent procedure. This procedure was most often performed in patients with Marfan syndrome, however, it has its own technical difficulties. Hereby, we report on combined heart transplantation and Aortic root replacement using donor’ s ascending aorta in a 25-year-old man diagnosed with dilated cardiomyopathy and ascending aorta aneurysm. This procedure was successful and beneficial to patients with aortopathy who are candidates for heart transplantation.

Herein, we present a case with clinical and laboratory manifestations of infectious endocarditis but in echocardiography, the ventricular septal defect and bicuspid Aortic valve were detected without any vegetation. However, an Aortic root pseudoaneurysm was first suspected in transesophageal echocardiography and then confirmed in computed tomography angiography of the aorta that points to importance of searching infectious endocarditis complications even in absence of vegetation.

Infective endocarditis can cause several major complications, including valvular destruction, aneurysm formation, and Aortic ring abscesses, and pseudoaneurysm formation in left ventricular outflow tract (LVOT) is quite a rare complication of infective endocarditis. Here, we present a rare case which had two simultaneous LVOT pseudoaneurysms, a bicuspid Aortic valve (BAV) and abscess formation along with the presence of anerobic bacteria (Peptostreptococcus) in the tissue culture. We describe echocardiographic, computed tomography angiography findings, and the result of surgical repair. This is a unique case with 2 LVOT pseudoaneurysms, a BAV, and anerobic bacteria in the tissue culture which became complicated as a result of delayed intervention due to fear of coronavirus disease 2019.

Background: The increasing use of biologic conduits and the advances in reparative Aortic root procedures has increased the number of patients who may require reoperation on the Aortic root. Although the primary operation yields excellent results with a low risk for morbidity and mortality, reoperation on the Aortic root is still challenging.Methods: We reviewed retrospectively our experience in 46 patients (38 men; mean age, 57±11 years) who underwent Aortic root reoperations in the last 7 years. Of these, 42 had received prior Aortic root replacement. The indications for reoperation included prosthesis infection in 16, false aneurysm in 16, and degenerative or postdissection aneurysm and valve prosthesis failure. Aortic root re-replacement was performed in 39 patients (85%) and closure of false aneurysm in 7. Univariate and multivariate analysis on 22 perioperative variables were performed.Results: In-hospital mortality was 6.5% (3 patients). The postoperative course was complicated in 19 (41%). At multivariate analysis, perioperative myocardial infarction was a risk factor for hospital mortality (2 patients). Survival was 88% at 1 year and 74% at 5 years. No differences were found in survival according to redo indication. Freedom from reoperation on the Aortic root was 100% at 1 year and 90% at 5 years.Conclusions: Reoperation on the Aortic root can be performed with acceptable mortality and good midterm and long-term outcome; however, the postoperative complication rate is still high.

Three case reports are presented to emphasize the importance of 18FDG PET-CT as part of the initial workup of patients presenting with suspicious stent graft infection. In these cases, the diagnosis of infected stents-grafts were diagnosed initially based on the abnormal uptake in the 18FDG PETCT scan.The first patient is a case of thoracic Aortic graft infection detected by 18FDG PETCT scan. Her CT angiography was negative for infection. The second patient had an Aortic root abscess and prosthetic valve endocarditis as seen by abnormal uptake in the 18FDG PETCT. Her previous echocardiography was negative for any signs of infection. The third patient had pulmonary artery stent infection as suggested by the abnormal 18FDG PETCT findings.Both her trans esophageal echocardiography and trans thoracic echocardiogram were negative for any site of infection.These cases highlight the importance of FDG PET CT in diagnosing stent grant infection in the background of negative findings in other imaging modalities. In some cases, FDG PET CT could be the most sensitive and specific test in detecting this condition. It may be used as an initial and follow up test in selected patients with stent-graft infection.

Background- An obvious substitute for the diseased Aortic valve is a healthy duplicate. Despite increasing experience in a half century, the search for an ideal valve replacement for a diseased Aortic valve continues.Homograft (allograft) Aortic valve is a good choice in endocarditis and complex Aortic valve and ascending aorta pathology.Methods- Between March 1996 and Oct. 2000, ten patients (3 females, 7 males), aged 16 - 58 years (mean 32.6) underwent Aortic root replacement using cryopreserved Aortic homograft, due to native or prosthetic Aortic valve endocarditis and aneurysm of ascending aorta.Results- The length of hospital stay was 10 to 85 days (mean 32.6) with one in-hospital death (%10). The patients were followed up for 1 to 90 months (mean 35.2) with no incidence of thromboemboli, endocarditis, or reoperation and are now in good functional class.Conclusion- Aortic root replacement is the procedure of choice in endocarditis. It could be done even in high-risk and redo patients with acceptable mortality.