# Malposition of an Internal Aortic Annuloplasty Ring After Acute Type A Aortic Dissection Repair

## TL;DR

A patient with a repaired aortic dissection developed complications from a misplaced aortic annuloplasty ring, requiring further surgery.

## Contribution

Reports a rare case of internal aortic annuloplasty ring malposition after acute type A aortic dissection repair.

## Key findings

- Malposition of the annuloplasty ring led to severe aortic insufficiency.
- The ring dislodged and adhered to the noncoronary leaflet during redo surgery.
- A mechanical aortic valve was required to replace the damaged structures.

## Abstract

Poor tissue quality of adventitia and intima makes aortic root repair complex in patients with acute type A aortic dissection. The management of aortic root repair remains controversial. Internal aortic annuloplasty devices provide a standardized aortic valve repair technique to reduce and prevent annular dilation, while the modified Florida sleeve (mFS) procedure is an aortic root remodeling technique that does not require coronary artery reimplantation. However, little is known about the long-term durability of internal aortic annuloplasty with the hemispheric aortic annuloplasty remodeling ring (HARRT) combined with a mFS procedure in acute type A aortic dissection repair. A 52-year-old man had initial type A aortic dissection repair with an internal aortic annuloplasty ring and a mFS technique. He presented with dyspnea on exertion and intermittent chest pain one year later. Transesophageal echocardiogram revealed malposition of aortic annuloplasty ring and severe aortic insufficiency. He underwent a redo sternotomy with aortic valve replacement. Intraoperative findings demonstrated the aortic annuloplasty ring had dislodged from under the left and right coronary annulus and was adherent to the base of the noncoronary leaflet. The annuloplasty ring and aortic valve leaflets were excised and replaced with a mechanical aortic valve.