[The Tirone Davis operation in a young patient with Marfan syndrome. Description of a clinical case].

We report a case of a young woman affected with Marfan's syndrome, with an ascending aortic aneurysm and mild aortic insufficiency, who underwent a valve-sparing operation as described by Tirone David. In many patients with Marfan's syndrome, aortic valve dysfunction is caused by dilatation of the sinotubular junction with distortion of the sinuses of Valsalva, and often with intact aortic valve leaflets. In these patients, if the aortic valve leaflets are normal at echocardiography, a more aggressive approach may be advisable in order to prevent irreversible damage to the aortic valve leaflets. We believe that surgery is indicated when the aortic root increases rapidly, even if it does not reach a diameter of 50 mm, which represents the current indication for asymptomatic patients with ascending aortic aneurysm. This makes it possible to perform a valve-sparing operation instead of the composite replacement of the aortic valve and ascending aorta, which is still considered the standard treatment for these patients. The procedure described here represents an attractive choice for managing aortic root dilatation and annuloaortic ectasia in Marfan patients, with the benefit of avoiding all the well-known complications involved in prosthetic aortic valves.