[Annulo--aortic ectasia. Prognosis and treatment].

Nine cases of aneurysm of the ascending aorta responsible for aortic insufficiency were identified between 1975 and 1989. Seven of these fell within the context of Marfan's syndrome, while the other 2 were idiopathic. Aortic leak was found to be massive from the outset in 5 cases and progressively worsened in 2 other cases. Mean follow-up was 138 months. Five patients were treated surgically, with nil mortality. Three corrective procedures were used: aortic valve replacement only or in combination with an additional procedure concerning the aorta (3 cases), or composite graft using the Bentall technique as modified by Cabrol (2 cases). There were 2 late complications among the incomplete procedures (detachment of the valve graft, recurrence of aneurysm). The 4 patients who did not undergo surgery all died: twice of aortic dissection and as a result of myocardial dysfunction in the other 2 cases. These results confirm the potentially grave course of this condition and emphasise the usefulness of routine surgery. Mastery of surgical techniques now justifies the extension of the indications of prophylactic surgery to any aneurysm having reached 6 cm. The Bentall technique modified by Cabrol remains the treatment of choice.