A 34-year-old male from Cameroon, with Marfanoid features was referred for aortic root replacement and mitral valve surgery. His echocardiogram showed severe ascending aortic dilatation more than 8 cm and severe mitral regurgitation. Preoperative TEE showed dilated aortic annulus and ascending aorta, dilated mitral annulus, with severe AR and MR. He was planned for Bentall procedure and mitral valve repair.2
Surgical technique
Under cardiopulmonary bypass and cardioplegic arrest, ascending aorta and the aortic valve was replaced with 25 mm Carbomedics valve bearing conduit with coronary implantation. Mitral valve showed normal leaflets with dilated annulus. Mitral annuloplasty was done using a 32 mm Carpentier-Edwards Physio ring. Post-op TEE showed no MR and normally functioning aortic prosthesis. He had a smooth post-op recovery and was discharged on seventh post-op day.
Discussion
Co-existing aortic root and mitral valve pathology is increasingly recognized among patients undergoing cardiac surgery. This combination of pathologies is particularly common in patients with connective tissue disorders such as Marfan syndrome. Aortic root replacement with mitral valve repair or replacement are the surgical options to treat these patients. However, the combination of the mitral valve operation and an aortic root procedure is more demanding than either major operation alone and knowledge regarding the clinical outcome is limited. The most common pathologies are root aneurysm without dissection and degenerative mitral valve disease. Combined aortic root and mitral valve operations are safe and associated with excellent long-term results.
