David procedure for aortic root aneurysm in the background of Marfan syndrome patient with severe kyphoscoliosis and previous mitral valve replacement

Abstract

Cardiac complication is one of the diseases that usually develop in Marfan syndrome patient such as mitral valve regurgitation and aortic root aneurysm. Apart from that, other congenital anomalies also tend to occur in this group of patients such as pectus excavatum and scoliosis. We report a case of successful high-risk surgery involving a Marfan syndrome patient who had underlying severe kyphoscoliosis and previous mitral valve replacement that underwent redo sternotomy and valve sparing aortic root repair (David procedure). The surgery was challenging due to the need to perform redo-sternotomy on severe pectus patient, performing valve sparing aortic root repair, and complicated with injury to right coronary artery require modified Cabrol modification for implantation of the coronary artery. The available literature about redo sternotomy on severe pectus excavatum for aortic root repair is limited, hence this paper aims to highlight the successful of performing the procedure, and the complication that might occur during the procedure.