Aortic valve repair for tri-leaflet aortic insufficiency associated with asymmetric aortic root aneurysms

The patient was a 47-year-old male with mild heart failure and an expanding 5.2-cm ascending aortic aneurysm. His sinuses also were involved, with a 6.3-cm aortic root diameter. He had Grade 4 aortic insufficiency (AI) (Figure 1) and his left ventricle and coronaries were normal. His aortic annulus was especially dilated at 30 mm. The right and non-coronary sinuses were primarily involved in the root aneurysm and his left sinus seemed normal. Echocardiography showed the dilated annulus, leaflet tethering from the sinotubular junction (STJ) dilatation and normal appearing leaflets. The AI was central and severe with stretching of the leaflets and loss of central coaptation. No leaflet prolapses or other defects were evident