Bentall-De Bono Technique in the Ascending Aorta Aneurysm, Aortic Regurgitation, and Coronary Reimplantation

Abstract

The aortic regurgitation (AR) is the backflow of blood, from the aorta to the left ventricle, through the aortic valve during diastole. In elderly patients, the most frequent cause, of AR, is the enlargement of the aortic annulus. This regurgitation can be the result of a primary disease, which causes dilation of the ascending aorta or sinus of Valsalva, or can be caused by aortic dilatation, when it occurs with other diseases that affect the valve ring and the aorta, such as hypertension, resulting in an ascending aneurysm. We report the case of a male patient with dyspnea and angina during moderate efforts, whom was diagnosed with hypertension 10 years ago and was being treated. The cardiovascular physical examination identified a systolic murmur (3+/6+), audible in the aortic focus, preserved B1 and hypophonic B2, and a palpable ictus displaced inferiorly and to the left. Exams were performed, and the final diagnosis was an aortic valve insufficiency associated with an ascending aortic aneurysm, with a transverse diameter of 65 mm, and a left ventricular hypertrophy, with a left ventricular ejection fraction of 50%. In patients that have both diseases, the replacement of aorta and aortic valve, by a valvar tube, performed by the Bentall-De Bono technique, and the reimplantation of the coronary ostiums, is the gold standard, having a very high survival rate of 87%, at 10 years. The surgery, in this case, was successful, reducing the aortic diameter to 30 mm and maintaining normal values for LV function. It is recommended for these patients a biannual follow-up, for the first years, and annual after.