Figure Legend
Fig.1 The yellow-arrow shows the anomalous LCA, originating from the right coronary artery (white-arrow) at multiplanar CT-scan (Fig.1A; Blu: aortic root; Red: coronary arteries). The LCA (black-arrow) was completely skeletonized and surrounded by a yellow vessel-loop before cusp removal (Fig.1B). U-stiches with soft-pledgets on the ventricular side were used, paying attention to avoid any LCA involvement (Fig.1C). After valve replacement, accurate evaluation of the field to verify the absence of LCA (black-arrow) compression (Fig.1D).
Fig.2 Postoperative CT-scan after a mechanical valve replacement (white-arrow, Fig.2A) and after a sutureless implantation (red-arrow, Fig.2B). The yellow arrow shows the anomalous LCA, not compressed by the sewing/basal rings nor by the left atrium (L.A.).