Aortic root remodeling and external aortic annuloplasty to treat sinus of Valsalva aneurysm in a patient with complete s
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CASE REPORT
Open Access
Aortic root remodeling and external aortic annuloplasty to treat sinus of Valsalva aneurysm in a patient with complete situs inversus Charline Pujos, Marie-Catherine Morgant, Ghislain Malapert and Olivier Bouchot*
Abstract Background: Sinus of Valsalva aneurysm is an uncommon anomaly of the aorta. It occurs most frequently in the right sinus of Valsalva. Complications depend on its size and location. Situs inversus totalis is a rare condition wherein organs are reversed from their normal positions (mirror image). Case presentation: We report the case of a 69-year-old man who presented situs inversus totalis known since his childhood and a sinus of Valsalva aneurysm in the right coronary sinus discovered by echocardiography following a history of infection. This was confirmed by CT-scan and MRI. Valve sparing surgery was performed using the remodeling technique associated with external aortic annuloplasty Conclusions: The remodeling technique with exteranl aortic annuloplasty is usual technique to treat SVA Keywords: Sinus of Valsalva aneurysm, Congenital heart disease
Background Sinus of Valsalva aneurysm (SVA) is the least common of all aortic aneurysms; it is usually a rare congenital anomaly [1]. Surgical repair is recommended due to a possible risk of rupture. Similarly, situs inversus totalis is a rare congenital anomaly. We present herein the case of a patient with known situs inversus totalis associated with right coronary SVA, which was discovered fortuitously. Case presentation The patient was a 69-year-old man with a medical history of repeated urinary tract infections due to the use of a urinary catheter following a transurethral resection of the prostate. The SVA was discovered during a clinical checkup for aortic regurgitation because of suspected infective endocarditis. In addition, this patient had situs inversus totalis known since childhood. The transthoracic echocardiogram (Fig. 1) showed a right SVA of 34 mm prolapsing into the right ventricle, * Correspondence: [email protected] Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, 14 rue Paul Gaffarel, 21079 Dijon cedex, France
an ascending aorta measuring 43 mm and grade-2 central aortic regurgitation through a tricuspid valve. The left ventricular ejection fraction was preserved. Coronary CT angiography (Fig. 2) and Magnetic Resonance Imaging (Fig. 3) showed an aortic root measuring an estimated 50 mm. The ostium of the right coronary artery was located in the anterior left sinus of Valsalva, and the ostium of the left coronary artery was located in the anterior right sinus of Valsalva. Surgery was indicated because of the association of SVA, moderate dilation of aortic root and ascending aorta, and moderate aortic regurgitation, in a context of chronic urinary infectious disease without proof of aortic valve endocarditis. The procedure was performed through a median sternotomy. Cardiopulmonary bypass was established with intermittent antegrade warm blood myocardial protection. P
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