Previous type A aortic dissection 

with 

interposition tube graft and resuspension of aortic valve

The patient now presents with gross AR and is breathless. What would you do ?

Depending on how long ago and the patients risk factors and age, you need to consider a coronary angiogram. Echocardiography to eliminate other valvular lesions is also important. CT scanning will also help evaluate the aorta to help in where to cannulate and if any bits of the aorta have subsequently become aneurysmal.

It turns out his patient had a dissected arch and descending aorta, which was not so aneurysmal that it needed replacing, but the patient had isolated severe AR.

This patient needs an AVR. Cannulation of the femoral artery or the right axillary artery is needed. The previous Dacron graft can be cross clamped and opened. the old aortic valve can be removed and a new one inserted. Re repair although maybe feasible may not be the best solution.