Minimally invasive bicuspid aortic valve repair with external ring annuloplasty

A 65-year-old man with hypertension presented with shortness of breath and III/IV diastolic murmur. Transesophageal echocardiogram (TEE) showed a bicuspid aortic valve with prolapse of the conjoint right (RC) and non-coronary (NC) cusp. Severe eccentric aortic regurgitation (AR) directed towards the anterior leaflet of the mitral valve was also noted. The measurements of the aortic annulus, sinuses of Valsalva and sinotubular junction (STJ) were 32, 40 and 34 mm respectively