Minimally Invasive Modified Bentall Operation in a Young Chinese Male with Severe Aortic Regurgitation Secondary toInfective Endocarditis in the Background of Bicuspid Aortic Valve Having a Rudimentary Coronary Ostia: A Case Report

Objective: To describe the first case of minimally invasive modified Bentall Operation done at our institution that resulted in an excellent outcome. Method: We describe a 28 year old Chinese male, without past medical history and risk factors, who presented with sudden shortness of breath on exertion associated with one month duration of lethargy and intermittent fever and was diagnosed with severe aortic regurgitation secondary to infective endocarditis on echocardiography. He was planned for a minimally invasive aortic valve replacement. Intra-operatively, the aortic wall was noted to be infected with vegetation in the background of bicuspid aortic valve and decision was made on table to perform minimally invasive modified Bentall Operation. He was also noted to have a rare presentation of rudimentary left coronary ostia, with only single right coronary ostia which supplies to the 3 coronary arteries. Results: The patient had an uncomplicated clinical course post-operatively and was discharged on post-operative day five in excellent condition. He was started on life-long anticoagulation. The patient was asymptomatic on follow-up and is progressing well. Conclusion: The initial surgical plan was for minimally invasive aortic valve replacement, but it was a decision made on table that changed to a minimally invasive modified Bentall Operation. The patient subsequently did well and benefitted from the advantages of a minimally invasive heart surgery.