Aprotinin and renal dysfunction: The role of exposure to angiotensin-converting enzyme inhibitors

with bicuspid aortic valves excluded from the study? Did patients with Gothic arches and bicuspid valves have even greater changes? Did any of the patients with Gothic arch and a tricuspid aortic valve have aortic insufficiency or require valve replacement/repair? Approximately 15% of patients who are status-post repair of type I aortic dissection require replacement of the proximal descending aortic owing to increasing diameter on long-term follow-up. It has also been my impression that those patients who have repair of type I aortic dissection with replacement of the ascending aorta andhemiarchrepairhaveagreaterincidence of progressive aortic insufficiency and may require aortic valve replacement or aortic root replacement. This cohort is in contrast to those patients with type I aortic dissection who simply had ascending aortic replacement and appeared to have a lesser incidence of aortic insufficiency and valve or root replacement over the long term. Might the hemodynamic changes that were documented in the pediatric angular Gothic arch be present in this status-post aortic dissection group and predispose to aortic valve insufficiency and dilation of the proximal portion of the distal descending thoracic aorta? Might this effect be more pronounced in the hemiarch repair that predisposes to an angular Gothic arch configuration? Replacement of the ascending aorta only (without hemiarch repair) usually preserves the concave configuration of the ascending aorta and its gentle curve into the transverse arch. Ascending aorta and hemiarch replacement typically has an angulated Gothic configuration rather than the gentle curve that nature favors.