Severe Neoaortic Root Aneurysm

A 28-year-old male patient presented with dyspnea on moderate exertion and episodes of tachycardia. 17 years earlier he underwent open heart surgery for congenital subvalvular aortic
stenosis. Five years later he underwent Ross procedure for severe aortic valve insufficiency. During the Ross procedure the pulmonary artery was replaced with a xenograft. On examination, TTE showed 70 mm neoaortic root aneurysm, severe neoaortic valve insufficiency and enlarged left ventricle (LVEDD of 73 mm). Another finding was severe calcified stenotic xenograft in pulmonary position with a mean gradient of 41 mmHg.
Tricuspid valve was fully competent. Computed tomography confirmed the diagnosis (Fig. 1). The patient underwent a modified Bentall procedure with an excision of the calcified pulmonary
valve and a patch repair of pulmonary xenograft. Postoperative period was uneventful.

Figure 1. Computed tomography scans showing neoaortic root aneurysm (asterisks) and a severe
calcified and stenotic xenograft in pulmonary position (arrows).

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