When a patient has an aneurysm of the aortic root, the aortic valve may also be damaged. Depending on how well the valve is functioning, it may need to be replaced or repaired when the aortic root aneurysm is repaired.
Consideration of valve repair begins with examination of the valve on echocardiogram: Is it normal? Does it leak? Are the leaflets stuck? Are there holes (fenestrations) in the leaflets? Are there two leaflets or three?
If the aortic valve appears normal, repair may be possible. We then carefully examine the valve at the time of surgery. Time is spent in evaluating the integrity of the leaflets, how they touch one another, and how they relate to the base of the heart. If, after this detailed analysis, we believe a repair is indicated, then we will perform a valve-sparing procedure. If the aortic valve is stenotic or calcified, we must determine whether the area of damage is restricted to one area, in which case it still may be rebuilt. However, if the damage is widespread enough, it will require replacement as there is little value in performing an inadequate repair.