Successful aortic valve-sparing procedure for an aortic root aneurysm associated with a congenital defect of the right sinus of Valsalva-a case report

Background: Aneurysm of the sinuses of Valsalva (ASV) is a rare but potentially lethal condition. Young patients with aortic root aneurysm and normal aortic valve are preferentially treated with a valve -sparing root replacement (VSRR). However, this option may not be feasible in the presence of an ASV. We herein describe a unique repair technique that allows ASV closure and subsequent VSRR. Case Description: A 50 -year -old patient with a dilated aortic root was referred to our clinic. Upon examination of the aortic root, a localized disruption of the aortic wall between the annulus and the right coronary artery was identified. This finding jeopardized the feasibility of a valve -sparing procedure. A primary repair of the congenital aneurysm was attempted using a series of interrupted sutures. This successfully recreated the continuity between the valve annulus and the aortic wall. Reimplantation was then carried out in a standard fashion and the postoperative echocardiography showed good aortic valve and cardiac function. Alternatives to this technique include the Bentall procedure which does not require any continuity between the aortic annulus and the sinuses. However, it has been associated with a higher incidence of valve -related complications. Conclusions: Direct closure of an ASV can allow successful valve -sparing. It represents an attractive option in young patients with a repairable aortic valve.