# Commissural Prolapse: Combining the Best From Two Aortic Valve Repair Techniques

## TL;DR

This paper presents a rare case of aortic valve commissural avulsion and describes a successful repair using a combination of two surgical techniques.

## Contribution

The novel contribution is the combined use of the Lansac and David techniques for aortic valve repair in a rare commissural avulsion case.

## Key findings

- The combined surgical approach achieved stable root geometry and good leaflet coaptation.
- Postoperative imaging showed mild central regurgitation and improved left ventricular function.
- Multimodality imaging was crucial for diagnosis and guiding the tailored repair strategy.

## Abstract

Aortic valve commissural avulsion is an exceptionally rare and often underdiagnosed cause of aortic regurgitation. We report a 30-year-old male with severe chronic aortic regurgitation and a mildly dilated aortic root, in whom intraoperative inspection revealed spontaneous avulsion of the right–noncoronary commissure. The patient underwent valve-sparing aortic root replacement using a combined approach: remodelling root replacement with external annuloplasty according to the Lansac technique, and targeted commissural reinforcement based on David principles. Postoperative and 6-month imaging showed stable root geometry, good leaflet coaptation, mild central regurgitation, and improved left ventricular function. This case highlights the diagnostic value of multimodality imaging and illustrates that tailored application of established valve-sparing techniques can achieve durable repair in rare commissural lesions.

Commissural avulsion of the aortic valve is a rare cause of aortic regurgitation (AR) and is most commonly associated with trauma, infective endocarditis, or aortic dissection.