A Y-incision to enlarge the aortic root for aortic valve stenosis with anomalous aortic origin of the right coronary...

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Cardiac Imaging

Background:

• Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital heart defect.
• Optimal surgical indications for severe aortic stenosis (AS) in patients with AAOCA are not well-established.

Observation:

• A 57-year-old male with severe AS and anomalous aortic origin of the right coronary artery (AAORCA) underwent aortic valve replacement (AVR).
• Preoperative imaging showed no ischemic lesions.
• A Y-incision aortic root enlargement was performed to avoid prosthetic valve compression on the AAORCA and prosthesis-patient mismatch.

Findings:

• Aortic root enlargement with a Y-incision is a viable surgical strategy for AS in the presence of AAOCA.
• This approach effectively addresses potential complications related to coronary artery anatomy and valve sizing.

Implications:

• Preoperative assessment of coronary anatomy and myocardial ischemia is crucial.
• Advanced imaging modalities aid in surgical planning for complex congenital heart disease.
• Aortic root enlargement with the Y-incision procedure can prevent ischemic complications in patients with severe AS and AAORCA.