PMC9633687_01
(A) The two-dimensional echocardiogram showed a 10.6 mm x 9.6 mm ruptured sinus of Valsalva aneurysm (right coronary sinus) and a 5.0 mm aortocardiac shunt (white arrow). (B) No residual shunt or valve regurgitation noted on the postoperative echocardiogram. LA, left atrium; LV, left ventricle; RV, right ventricle; Ao, aorta.
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F1
Transthoracic echocardiography (TTE) showed a 10.6 mm x 9.6 mm dilated SVA with a ruptured right coronary sinus into the right ventricular outflow tract (RVOT) (Figure 1A). At the 12-month follow-up, TTE demonstrated no residual shunt or valve regurgitation (Figure 1B).
Schematic diagram of the thoracoscopic procedure. (A) The patient was positioned in a supine position with the right chest elevated by 15 degrees. The working port was placed at the third intercostal space on the mid-clavicular line, while the thoracoscopic port was made in the third intercostal space at the level of the anterior axillary line. (B) Thoracoscopic approach view. (C) To fully expose the aortic root, two or three retraction sutures were placed over the transected aorta.
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F2
After insertion of a double-lumen tracheal intubation under general anesthesia, the patient was placed in the supine position with the right chest elevated by 15 degrees (Figure 2A). A soft tissue retractor was inserted into the working port established in the third intercostal space lateral to the right midclavicular line (Figure 2B). The assistant port was made in the third intercostal space in the anterior axillary line, where the thoracoscope, an aortic cross-clamp and a left ventricle vent catheter were placed (Figure 2A). In total, two or three retraction sutures were placed over the transected aorta to achieve full exposure of the aortic root (Figure 2C).