Repair of torn aortic root with the left atrial appendage

A narrow aortic root and a small aortic annulus made aortic valve replacement in a 35-year-old female patient with calcified aortic stenosis rather difficult. At the end of the procedure, it was noticed that the aortic root was badly torn. The tear started at the end of the aortotomy incision, near the commissure between the non-coronary and left coronary cusps, ran flush with the prosthetic ring and extended beneath and a few millimeters beyond the ostium of the left coronary artery. Only a thin rim of the aortic wall was left proximally, which was not strong enough to support the sutures. The aorta was repaired using a pericardium covered Goretex patch, bolstered by the left atrial appendage.