Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Valve-Sparing Root Replacement in a Turner Syndrome Patient with Bicuspid Aortic Valve and Juxtacommissural Origin of the Right Coronary Artery: A Case Report

  • Son, Dong Hyeon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Cho, Sungkyu (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine) ;
  • Song, Mi Kyoung (Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine)
  • Received : 2022.01.17
  • Accepted : 2022.05.18
  • Published : 2022.10.05
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Abstract

A 32-year-old woman diagnosed with Turner syndrome presented to the hospital for an evaluation of cardiovascular complications. Preoperative computed tomography (CT) and echocardiography showed progression of aortic root and ascending aorta dilatation, as well as a bicuspid aortic valve. There was no evidence of aortic regurgitation. We planned valve-sparing aortic root replacement and ascending aorta replacement with a high risk of aortic rupture. Intraoperatively, we incidentally found a juxtacommissural origin of the right coronary artery (RCA). We performed aortic valve reimplantation using a graft designed with a key-shaped hole to wrap the juxtacommissural-origin RCA by modifying the Florida sleeve technique. Coronary blood flow was patent on postoperative CT angiography, and there was no evidence of aortic regurgitation on postoperative echocardiography. The patient was discharged from the hospital on postoperative day 7 without any complications.

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References

  1. Naito S, Petersen J, Reichenspurner H, Girdauskas E. The impact of coronary anomalies on the outcome in aortic valve surgery: comparison of bicuspid aortic valve versus tricuspid aortic valve morphotype. Interact Cardiovasc Thorac Surg 2018;26:617-22. https://doi.org/10.1093/icvts/ivx396
  2. Hess PJ Jr, Klodell CT, Beaver TM, Martin TD. The Florida sleeve: a new technique for aortic root remodeling with preservation of the aortic valve and sinuses. Ann Thorac Surg 2005;80:748-50. https://doi.org/10.1016/j.athoracsur.2004.02.092
  3. Freeman KA, Arnaoutakis GJ, Jeng EI, Martin TD, Beaver TM. Florida sleeve operative technique. Oper Tech Thorac Cardiovasc Surg 2021;26:306-21. https://doi.org/10.1053/j.optechstcvs.2020.11.001
  4. Hess PJ Jr, Harman PK, Klodell CT, et al. Early outcomes using the Florida sleeve repair for correction of aortic insufficiency due to root aneurysms. Ann Thorac Surg 2009;87:1161-9. https://doi.org/10.1016/j.athoracsur.2009.01.016
  5. Aalaei-Andabili SH, Martin TD, Hess PJ, et al. The Florida sleeve procedure is durable and improves aortic valve function. Aorta (Stamford) 2019;7:49-55. https://doi.org/10.1055/s-0039-1687854
  6. Wu YS, Hsieh SR, Wang CC, Tsai CL. Modified sleeve technique in aortic valve-sparing operation for Marfan syndrome. Ann Thorac Cardiovasc Surg 2019;25:164-7. https://doi.org/10.5761/atcs.cr.17-00227
  7. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014;35:2873-926. https://doi.org/10.1093/eurheartj/ehu281