The echocardiographic W sign in aortic valve regurgitation and aortic valve repair

An active 81-year-old man with diabetes, hypertension, hypothyroidism, and decreasing exercise tolerance was referred for evaluation of his aortic regurgitation. Transthoracic echocardiography (TTE) demonstrated severe eccentric aortic regurgitation (AR) with a trileaflet aortic valve (AV), a 3.9-cm aortic root, and normal biventricular function. One week later, he was electively taken to the operating room for AV repair, supported by a valve-sparing aortic root replacement (VSARR). Although an isolated AV repair was considered, our rationale for this approach is that stabilizing the annulus and sinotubular junction with a VSARR during AV repair seems to provide the most durable repair possible.