Mini-access David Procedure with endoscopic assessment of aortic valve competency: the "Snorkelling" technique.

A 58-year-old man was referred with an incidental finding of an aortic root aneurysm. He had no significant medical history. Computed tomography (CT) aortogram demonstrated an isolated aortic root aneurysm (aortic annulus 28 mm, aortic root 53 mm, sinotubular junction 53 mm). Transthoracic echocardiogram demonstrated a dilated aortic root and a tri-leaflet aortic valve with mild aortic regurgitation (AR). The left ventricular (LV) ejection fraction was preserved. Cardiac catheterization demonstrated mild non-obstructive coronary artery disease only. Given the patients’ age, structurally normal-appearing valve and borderline annular dimension, minimally-invasive aortic valve reimplantation was planned. The minimally invasive approach was based on surgeon and patient preference.