A Case Report of a Valve-sparing Aortic Root Replacement Performed for Annuloaortic Ectasia with Anomalous Origin of Right Coronary Artery

Abstract

There are few previous reports of valve-sparing aortic root replacement (David Procedure) in the setting of annuloaortic ectasia with an anomalous right coronary artery origin. A 45 year-old male with an abnormal mediastinal silhouette on screening chest X-ray was found to have a dilated aortic root with valvular regurgitation. Preoperative contrast-enhanced CT revealed that the right coronary artery arose from the left sinus of Valsalva and traversed between the aortic root and pulmonary trunk. Given his age and relatively normal appearing valve leaflets, the above operation was chosen. Regarding the anomaly, the two coronary ostia were in close proximity resulting in a practically single trunk. Excision of the left coronary button was manageable, but the right coronary artery was completely exposed and was implanted directly into the prosthetic graft. Of note, the aortic cross-clamp was removed temporarily to allow the graft to fill with blood allowing selection of the most suitable location for the anastomosis. In planning the coronary reconstruction, the preoperative coronary CT was quite useful.