# A Y-incision to enlarge the aortic root for aortic valve stenosis with anomalous aortic origin of the right coronary artery

## TL;DR

A new surgical approach using a Y-incision is described for treating aortic valve stenosis in patients with a rare heart condition involving an anomalous coronary artery.

## Contribution

The paper introduces a Y-incision aortic root enlargement as a novel surgical strategy for aortic valve stenosis with anomalous aortic origin of the right coronary artery.

## Key findings

- A Y-incision aortic root enlargement was successfully used in a patient with severe aortic valve stenosis and anomalous aortic origin of the right coronary artery.
- Preoperative imaging and careful planning helped prevent ischaemic complications during surgery.
- The approach avoids potential compression of the prosthetic valve on the anomalous coronary artery.

## Abstract

Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital heart disease. Therefore, optimal indications for surgery in patients with severe aortic valve stenosis (AS) complicated by AAOCA remain uncertain.

We report the case of a 57-year-old male patient who underwent aortic valve replacement (AVR) and aortic root enlargement using a Y-incision procedure for severe AS with an anomalous aortic origin of the right coronary artery (AAORCA). Since preoperative single-photon emission computed tomography revealed no ischaemic lesions, an aortic root enlargement with a Y-incision was performed to prevent the potential compression of the prosthetic valve on the AAOCA and prosthesis-patient mismatch.

Preoperative evaluation of the coronary anatomy and myocardial ischaemia using advanced imaging modalities and aortic root enlargement with the Y-incision procedure is an effective strategy for preventing ischaemic complications in cases of severe AS with AAORCA.