[Transesophageal echocardiography follow-up of patients operated on using the Bono-Bentall technique in aneurysms or dissection of the ascending aorta].

INTRODUCTION: Increasingly patients are surviving after reconstructive surgery of the ascending aorta. These patients require follow-up to detect postoperative prognostic markers, such as persistence of the flow in a false lumen, intimal rupture, or graft complications. We conducted a study with transthoracic and transesophageal echocardiography in order to detect residual abnormalities and establish the usefulness of this technique in a group of patients after Bono-Bentall surgery for ascending aorta pathology.

PATIENTS AND METHODS: Twelve patients were studied with transthoracic and transesophageal echocardiography, four after surgery for annulo-aortic ectasia with severe aortic insufficiency and eight for type A aortic dissection. The Bono-Bentall surgical procedure was used in all the patients with Cabrol's modification being added in three.

RESULTS: Seven of the eight (87%) patients with aortic dissection had residual abnormalities: five persistence of the distal dissection, one pseudo-aneurysm, and one peritubular haematoma. A residual lesion (pseudo-aneurysm) was found in just one of the four patients (25%) who underwent surgery for annulo-aortic ectasia. The ejection fraction was normal in those patients who had been operated on for aortic dissection and depressed in those who had annulo-aortic ectasia (60 +/- 9 vs 40 +/- 10; p = 0.005).

CONCLUSIONS: In patients undergoing surgery with the Bono-Bentall procedure there is a high incidence of residual aortic abnormalities, especially when the operation is for aortic dissection. Transesophageal echocardiography is an ideal diagnostic method for the detection and follow up of residual abnormalities after ascending aorta surgery. We believe this technique should be included in the periodic follow up of these patients.