A 64-year-old man was admitted to our hospital because of a feeling of compression of the chest 5 years previously. Aneurysm of the right sinus of Valsalva was unexpectedly diagnosed by detailed examinations. He was admitted for the surgery, because dilated aneurysm caused severe stenosis of right ventricular outflow tract (RVOT) and aortic regurgitation (AR) progressed. He underwent surgical repair consisting of patch closure of the aneurysm, aortic valve replacement, right coronary artery (RCA) bypass grafting with right internal thoracic artery (RITA), and aneurysmal wall was closed with suture after partial resection. The postoperative course was uneventful. Postoperative angiography revealed that aneurysm of the right sinus of Valsalva was not enhanced and the RITA graft was patent. The pressure gradient between RV and PA immediately reduced after operation. Postoperative CT showed that the stenosis of the RVOT completely disappeared with the elimination of the aneurysm.

The patient was a 57-year-old woman. In 1974, she had undergone aortic valve replacement using a Starr-Edwards ball valve to treat aortic stenosis at another hospital. In 1989, she had undergone percutaneous transluminal mitral commissurotomy (PTMC) for mitral stenosis at our hospital. In December 2003, she was admitted with cardiac failure of NYHA III to our hospital. Echocardiography showed the progressive changes of mitral stenosis and the prosthetic aortic valve. In January 2004, the mitral valve was replaced using a Carbo Medics prosthesis and the Starr-Edwards aortic valve was replaced using a BICARBON prosthesis, together with tricuspid ring annuloplasty. The cloth wear of the Starr-Edwards valve cage and a pannus formation at the valve seat was found at operation. The patient was discharged, and now is rehabilitated in good health.