Patient Demographics: 45 year old male patient
Relevant History: Dyspnea on exertion, Severe regurgitation of a bicuspid aortic valve type1LR, aortic anulusdilatation 30mm
Pre-Operative Plan: Minimal invasive aortic valve repair or mechanical aortic valve replacement
Discussion: Partial upper sternotomy and cannulation of aorta and right atrium (via superior vena cava). Aortic valve repair with cusp plications (Fig.1), superficial resection of localised cusp thickening in raphe area. External (subcoronary) aortic anuloplasty with tailored ring of a 32mm Dacron prosthesis which is fixed by subanular sutures (Fig.2). Postoperative TEE showed completely competent valve. Uneventful postoperative course.