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.