Repair of a Sinus of Valsalva Aneurysm using Geometric Ring Annuloplasty

J. Baker¹, V. Badhwar², J. Scott. Rankin^2
1Missouri Baptist Hospital, St. Louis, Missouri ²West Virginia University, Morgantown, West Virginia

Please explain the educational or technical point that this video addresses.: How to repair sinus of Valsalva aneurysm

Please provide a 250 word summary of the surgical video being submitted.: Aneurysms of the Sinus of Valsalva (SOV) can compress adjacent structures and cause aortic valve insufficiency (AI) by annular distortion. Simply removing the aneurysm solves the local compression, but restoration of annular geometry is required for uniform recovery of valve competence. This video illustrates management of a large SOV aneurysm and aortic valve repair, using geometric ring annuloplasty and remodeling root replacement. A 64-year-old man presented with arrhythmias and heart failure, and had a 6.4 cm right SOV aneurysm discovered, associated with moderately severe AI and distortion of both the pulmonary and mitral valves. The valve was repaired with a 25 mm geometric annuloplasty ring, and the aneurysm was replaced with a single tongue of a remodeling root graft, sutured to the base of the sinus without resection of the aneurysm. After bypass, the aortic valve was fully competent with a low mean gradient and competent pulmonary and mitral valves. Postoperative CT angiography of the aortic root showed a normal 3-sinus appearance and full resolution of the aneurysm. The patient recovered uneventfully and resumed normal activity. Using this approach, virtually all SOV aneurysms can be repaired simply and with preservation of a fully repaired aortic valve.