Valve-sparing aortic root replacement for rapidly growing multiple sinus of Valsalva pseudoaneurysms in a case of Behçet's-like aortitis.

Fig 2View Large Image Figure ViewerDownload (PPT)Fig 3View Large Image Figure ViewerDownload (PPT)A 34-year old man, suspected and treated for Behçet's disease, had a computed tomographic angiogram (Fig 1A), magnetic resonance imaging (Fig 1B), and a transesophageal echocardiogram (Fig 1C) with a three-dimensional endoaortic view (Fig 1D) for recurrent pleuritic chest pain, which showed three psedoaneurysms arising from left and noncoronary sinuses of the aortic root (largest 2 cm). Intraoperatively largest pseudoaneurysm (∗) was protruding out toward the superior vena cava above the right pulmonary artery, impending rupture (Fig 2A). The internal openings of the three pseudoaneurysms are shown in (Fig 2B) with relation to left main coronary ostium (∗). All the pseudoaneurysms along with the sinuses were excised (Fig 2C), and valve sparing aortic root replacement (David's procedure) (Fig 2D) was performed along with plication of right coronary cusp with no aortic insufficiency. The pathological examination showed transmural inflammation of aortic wall with diffuse lymphocytic infiltrate in all layers and healing fibrosis around vasa vasorum (Fig 3A, hematoxylin and eosin stain with 20× magnification) and loss of internal elastic lamina (Fig 3B, elastic Van Gieson's stain with 10× magnification).