Aortic regurgitation is frequently associated to ascending aortic aneurysms and to dissections of the ascending aorta. In these cases, aortic regurgitation, in spite of the structurally and functionally normal appearing aortic cusps, is due to the dilatation of the sinotubular junction, aortic root and/or aortic annulus. Surgical replacement of the aortic valve and the ascending aorta with a composite graft was the only surgical modality in the treatment of these cases in the early years of this decade but aortic valve sparing operations in ascending aortic aneurysms described by David became a very strong alternative to the composite graft replacement in recent years. Three patients (two with ascending aortic aneurysm, one with type II aortic dissection) in whom 3 to 4 (+) aortic regurgitation was associated have undergone aortic valve-sparing operation at our department. Short-term follow-up of these patients showed that aortic regurgitation disappeared in one and was minimal (0 to 1 +) in two patients. With the very successful mid-to-long term results in the litterature and with the advantages of sparing the native aortic valve and not to use a mechanical aortic prosthesis, we therefore think that the David operation should always be considered in the surgical treatment of these cases.

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