2-2. Surgical treatment
Surgery was performed via median sternotomy on standard cardiopulmonary bypass under cold blood cardioplegic arrest with moderate hypothermia. The SVA originated from the left aortic sinus and expanded into the left extracardiac space. The ascending aorta was clamped and transected. The orifice of the SVA was approximately 20 mm in diameter, and it was located close to the left coronary ostium. However, the vascular wall of the left coronary ostium was preserved. The right and non-coronary sinuses were not dilated and had intact intimae. The aortic valve cusp was neither calcified nor thickened. Only the left aortic annulus was elongated because of an aneurysmal defect in the left sinus wall.
Patch repair (Hemashield Woven Double Velour Fabric; GETINGE) of the left sinus was performed. The patch was cut into a D-shape, similar to that of the other sinuses. The left sinus wall was resected and was replaced by the patch via interrupted sutures using 2-0 polyethylene terephthalate suture (ETHIBOND EXCEL, ETHICON).
The trimmed left coronary button was reattached to the left sinus patch using a 6-0 polyvinylidene fluoride suture (ASFLEX; CROWNJUN). The aortic sinotubular junction diameter was fixed at 30 mm in diameter with a polytetrafluoroethylene felt strip to prevent the exacerbation of aortic regurgitation caused by the dilatation of the sinotubular junction. For the stenotic lesions in the left coronary artery, coronary artery bypass grafting to the left descending artery using a saphenous vein graft was performed (Figure 3). No aortic regurgitation was observed on intraoperative transesophageal echocardiography.