PMC9110687_01
(A) Aortic valve insufficiency complicated with severe aortic regurgitation (AR). (B) Local obstruction of left ventricular outflow tract (LVOT) (gradients of LVOT 23 mmHg). AR, aortic regurgitation; LVOT, left ventricular outflow tract.
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F1
Based on findings observed from cardiac echocardiography, it was diagnosed as dilatation for both sinotubular junction and ascending aorta (annulus, 3.17 cm; sinus, max. 5.82 cm; proximal ascending aorta, 4.14 cm) and aortic valve insufficiency complicated with severe AR (Figure 1A). Meanwhile, local obstruction of LVOT was also detected (Figure 1B), the gradients of LVOT obstruction was 23 mmHg.
Diameter of aortic root 55.19 mm x 67.09 mm.
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F2
The preoperative thoracic CT scan showed the diameter of the aortic root was 55.19 mm x 67.09 mm (Figure 2).
(A) Aortic root was cut 3 mm above annulus. (B) Each cusp of leaflets was fixed within the artificial graft by horizontal mattress suture during proximal anastomosis.
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F3
The aortic root, 3 mm above the annulus, was cut (Figure 3A) and a 32-mm artificial graft was selected. The height for commissure of leaflets was adjusted reasonably and each cusp of leaflets was fixed within the artificial graft by horizontal mattress suture during proximal anastomosis (Figure 3B).
(A) atrophy and degeneration of smooth muscle in media of aortic wall (A x 50, hematoxylin, and eosin stain). (B) focal vitreous degeneration, myxoid degeneration (B x 200, hematoxylin, and eosin stain).
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F4
Postoperative pathology showed atrophy and degeneration of smooth muscle in media of the aortic wall, focal vitreous degeneration, myxoid degeneration, and calcium salt deposition (Figure 4).
(A) Left ventricular outflow tract obstruction disappeared (Gradients of LVOT 7 mmHg). (B) Trivial aortic regurgitation.
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F5
The follow-up echocardiogram 2 months after the operation showed significant improvement in local obstruction of LVOT (Gradients of postoperative LVOT 7 mmHg), with trivial aortic regurgitation (Figure 5).