Valve-Sparing Aortic Root Replacement and Neochordal Repair of Complex Aortic Leaflet Pathology for Ruptured Sinus of Valsalva Aneurysm Fistulizing to.

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Valve-Sparing Aortic Root Replacement and Neochordal Repair of Complex Aortic Leaflet Pathology for Ruptured Sinus of Valsalva Aneurysm Fistulizing to the Right Ventricle Y. Joseph Woo, MD, John R. Frederick, MD The Annals of Thoracic Surgery Volume 96, Issue 5, Pages 1891-1893 (November 2013) DOI: 10.1016/j.athoracsur.2013.05.008 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Screen shots of (A) composite color Doppler transesophageal echocardiographic aortic root short-axis and (B) 4-chamber views demonstrating the ruptured right sinus of Valsalva aneurysm (SVA) with left-to-right flow into the right ventricle (RV) (see Video 1). The Annals of Thoracic Surgery 2013 96, 1891-1893DOI: (10.1016/j.athoracsur.2013.05.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Intraoperative photograph of initial view of aortic root after mobilization of coronary buttons. The right button is at the bottom of the photograph. The dysmorphic, highly asymmetrical aortic valve leaflets are observed. The left/non commissure is multi-fenestrated. The sinus of Valsalva aneurysm (SVA) sac is prolapsing into the aortic root adjacent to the right coronary leaflet. (B) A forceps traverses the ruptured SVA into the RV. (C) The aneurysm sac viewed from the right atrium showing close involvement with the tricuspid valve annulus and leaflet tissue. (D) Right ventricle fistula repaired with a polyester patch. The Annals of Thoracic Surgery 2013 96, 1891-1893DOI: (10.1016/j.athoracsur.2013.05.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Intraoperative photograph depicting the initiation of the fusion of the left coronary leaflet and the diminutive noncoronary leaflet beginning with a CV6 Gore-Tex suture at the free margin. (B) The suture ends have been tied repeatedly and then brought through the commissural apex aortic wall to create a supporting aortic valve neochord. (C) Reconstructed aortic valve reimplanted into the root graft. (D) Static saline column testing demonstrating aortic valve competence. The Annals of Thoracic Surgery 2013 96, 1891-1893DOI: (10.1016/j.athoracsur.2013.05.008) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions