Repair of a Chronic DeBakey Type II Aortic Dissection With Aortic Valve Insufficiency.

Ascending aortic aneurysms with aortic insufficiency caused by chronic DeBakey type II dissections have been difficult to repair. A 70-year-old woman presented with heart failure, severe aortic insufficiency, and a large ascending aortic aneurysm. She had a trileaflet valve and a healed chronic proximal intimal flap. A 19-mm ring was sutured beneath the annulus, a 28-mm Dacron graft was anastomosed to zone 2, and the bovine innominate artery was connected to the graft. After bypass, the leaflets moved well, residual leak was negligible, and mean pressure gradient was 7 mm Hg. The patient recovered uneventfully.