| A Case of Modified Aortic Root
Remodeling for Valsalva Aneurysms of the Right and Noncoronary
Sinuses |
(Department of Cardiovascular Surgery, Japanese
Red Cross Nagoya First Hospital, Nagoya, Japan)
| Takenori Yamazaki |
Kouji Sakurai |
Hiroaki Hagiwara |
| Masaharu Yoshikawa |
Toshiaki Itou |
Toshiaki Akita |
| You Yano |
Toshio Abe |
|
|
A 61-year-old woman had extracardiac
unruptured aneurysms of the right and noncoronary sinuses of
Valsalva, detected incidentally on electrocardiogram taken for
a physical checkup. Two-dimensional echocardiography revealed
that the sizes of the aneurysm of the right and noncoronary sinuses
were 41×40 and 38×28mm respectively, but the shape of left coronary
sinus was almost normal. The aortic valve leaflet was normal
and the diameter of the aortic annulus and sinotubular junction
was 23 and 27mm respectively. The Doppler color-flow echocardiogram
showed moderate aortic regurgitation which resulted in prolapse
of the right aortic cusp due to deformity of the annulus. We
performed modified aortic root remodeling using a tailored Dacron
graft to preserve the native aortic valve. Right and noncoronary
sinuses of Valsalva were all excised with a small button of the
aortic wall around the ostia of the right coronary artery. The
left coronary sinus was left as it was. Then each commissure
received sub-commissural annuloplasty and was pulled up. The
defect of Valsalva was reconstructed with a 26mm Dacron tube
graft, the proximal end of which was tailored to a scallop shape
and that correspond to left coronary sinus was excised. The right
coronary artery was reimplanted utilizing the Carrel patch method.
Although we needed additional CABG to the right coronary artery
and IABP support due to vasospasm of the right coronary artery,
the postoperative course was uneventful. Echocardiography of
the aortic valve before discharge showed a normal function without
regurgitation.
Jpn. J. Cardiovasc. Surg. 31：399-403 (2002) |
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