Bentall operation in left sinus of valsalva aneurysm with anomalous origin of left coronary artery and severe aortic regurgitation

: We report a successful Bentall operation in a 74-year-old man with an unruptured left sinus of Valsalva aneurysm and aortic regurgitation. The coronary angiogram showed an absent left main trunk (split origination of left coronary arteries from the same left sinus of Valsalva). We implanted a stented bovine pericardial valve and a Valsalva tube graft as a composite graft. To reconstruct the coronary arteries, we made one left coronary button including both ostia of the left anterior descending coronary artery and circumflex artery, and reimplanted the coronary button with interposition of a short small synthetic graft. Excessive tension of the coronary ostia can be avoided and a new left main trunk can also be created in this manner. Postoperative course was uneventful.