Recurrent massive aneurysm of the ascending aorta after aortic root replacement with inclusion cylinder technique

Fig. 1. (a and b) Aortogram showing the composite aortic valve graft conduit (CVG) inserted as a cylinder within the dilated aortic root and ascending aorta (white arrows, CVG with Björk-Shiley mechanical valve; black arrows, native ascending aorta aneurysm). During the first procedure (inclusions cylinder technique) the composite aortic valve graft was inserted as a cylinder within the dilated aortic root, the coronary ostia were reimplanted into the Dacron graft and the native ascending aorta wrapped around the CVG. Reoperation consisted of the classical Bentall procedure. To maximize safety, the femoral artery was cannulated for initiation of cardiopulmonary bypass.