Case report
A 54-years old Caucasian male patient with a body mass index 31.2 kg/m2 with no history of congenital or adult cardiac illness presented with worsening exertional dyspnea. was referred to our institution because of diagnosed severe AR and aortic root aneurysm. He presented with worsening exertional dyspnea and had a history of chronic hepatitis C and unregulated arterial hypertension
Echocardiography demonstrated enlarged left ventricle with an end-diastolic diameter of 61 mm, left ventricle ejection fraction of 52%, and LVHT affecting the apex and lateral wall. Severe AR of a tricuspid aortic valve and an aortic root aneurysm were also detected. Computed tomography scan of aorta showed aortic root aneurysm with a diameter 6.81x6.20 cm (Figure 1). Coronary angiography detected a 40% stenosis of the left anterior descending artery.
The patient underwent a mediasternotomy. Cardiopulmonary bypass was initiated with cannulation of the ascending aorta and right atrium with mild hypothermia. Intermittent antegrade crystalloid cardioplegia (Custodiol) was delivered. Modified button Bentall procedure was performed using a mechanical valved conduit Carbomedics Carbo-Seal 25mm (LivaNova, London, United Kingdom). Intraoperatively, the trabeculations were confirmed by endoscopy (Figure 2) and as the ventricular function was preserved, it was decided to refrain from resection. The patient was weaned from CPB with mild inotropic support. Cross clamp time and CPB time were 88 and 128 minutes, respectively. The patient was transferred to the intensive care unit and extubated the same day. The patient was anticoagulated with warfarin on 4th postoperative day following removal of chest drains. The postoperative course was uneventful and he was discharged after 11 days in a sinus rhythm.
At 1-year clinical follow-up, the patient was in New York Heart Association class I. Transthoracic echocardiography showed a well-seated mechanical aortic prosthesis, end-diastolic diameter of left ventricle of 43mm with ejection fraction of 66%.