{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:29:59Z","timestamp":1787567399038,"version":"build-2736575974"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Progressive aortic root dilation represents a life-threatening sequela of uncorrected tetralogy of Fallot (TOF), predisposing patients to aortic regurgitation, dissection, and rupture. Valve-sparing aortic root replacement (VSARR) offers an attractive alternative to mechanical valve replacement by eliminating prosthesis-related complications and lifelong anticoagulation. However, experience with VSARR in unoperated adult TOF patients remains exceptionally limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a 35-year-old male with unrepaired TOF who presented with progressive exertional dyspnea, cyanosis, and atrial fibrillation. Comprehensive imaging revealed severe aortic root dilation (55.4\u2005mm), moderate-to-severe aortic regurgitation, perimembranous ventricular septal defect, infundibular stenosis, and secundum atrial septal defect. We performed single-stage surgical correction comprising ventricular septal defect closure, infundibular resection, pulmonary valvotomy with transannular patch, atrial septal defect closure with fenestration, and Yacoub remodeling VSARR. The patient tolerated the 208-min cardiopulmonary bypass procedure well, with immediate postoperative echocardiography demonstrating trivial aortic regurgitation. He was discharged on postoperative day 7 in sinus rhythm without complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case demonstrates the feasibility of combining Yacoub VSARR with primary intracardiac TOF repair in unoperated adults. The procedure successfully preserved native aortic valve function while correcting congenital anatomy, avoiding prosthetic valve-related morbidity. This approach may expand surgical options for adults with TOF-associated aortopathy, though long-term durability data are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1851997","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:10:31Z","timestamp":1787562631000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A combined valve-sparing aortic root replacement and primary tetralogy of Fallot repair in an unoperated adult: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Xuping","family":"Feng","sequence":"first","affiliation":[{"name":"Anesthesia Operation Center of West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dou","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Chengdu Shang Jin Nan Fu Hospital, West China Hospital of Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Wu","sequence":"additional","affiliation":[{"name":"Out-patient Department, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjun","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e007611","DOI":"10.1161\/CIRCIMAGING.118.007611","article-title":"Aortic root dilatation and aortic-related complications in children after tetralogy of Fallot repair","volume":"11","author":"Grotenhuis","year":"2018","journal-title":"Circ Cardiovasc Imaging"},{"key":"B2","doi-asserted-by":"publisher","first-page":"725","DOI":"10.21037\/cdt.2018.12.05","article-title":"Aortic dilatation in complex congenital heart disease","volume":"8","author":"Niwa","year":"2018","journal-title":"Cardiovasc Diagn Ther"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1016\/j.jtcvs.2018.09.148","article-title":"Valve-sparing aortic root replacement in children: outcomes from 100 consecutive cases","volume":"157","author":"Fraser","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1111\/ped.12932","article-title":"Mechanism of aortic root dilation and cardiovascular function in tetralogy of Fallot","volume":"58","author":"Seki","year":"2016","journal-title":"Pediatr Int"},{"key":"B5","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1093\/ejcts\/ezv446","article-title":"Valve-sparing aortic root replacement in adult patients previously operated for congenital heart defects: an initial experience","volume":"50","author":"Baliulis","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"105911","DOI":"10.1016\/j.ijscr.2021.105930","article-title":"Concomitant valve-sparing aortic root replacement with tetralogy of Fallot repair in a 30-year-old patient","volume":"82","author":"Nguyen","year":"2021","journal-title":"Int J Surg Case Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e99","DOI":"10.1016\/j.athoracsur.2019.01.010","article-title":"Concomitant valve-sparing aortic root replacement with repair of tetralogy of Fallot","volume":"108","author":"Adachi","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1378\/chest.112.3.676","article-title":"Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies","volume":"112","author":"Wan","year":"1997","journal-title":"Chest"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1007\/BF03009470","article-title":"Elevation of cytokines during open heart surgery with cardiopulmonary bypass: participation of interleukin-6 and -8 in reperfusion injury","volume":"40","author":"Kawamura","year":"1993","journal-title":"Can J Anaesth"},{"key":"B10","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1051\/ject\/201446197","article-title":"Attenuating the systemic inflammatory response to adult cardiopulmonary bypass: a critical review of the evidence base","volume":"46","author":"Landis","year":"2014","journal-title":"J Extra Corpor Technol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1016\/j.athoracsur.2006.12.043","article-title":"Valve-sparing operation for aortic root aneurysm late after mustard procedure","volume":"83","author":"Ono","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2290","DOI":"10.1161\/CIRCULATIONAHA.111.026153","article-title":"Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy","volume":"124","author":"Imazio","year":"2011","journal-title":"Circulation"},{"key":"B13","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1186\/s13019-024-02926-1","article-title":"Efficacy of atrial fibrillation predictors including MVP ECG risk score compared between single or bilateral internal thoracic artery use","volume":"19","author":"Erturk","year":"2024","journal-title":"J Cardiothorac Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1161\/01.CIR.0000028462.88597.AD","article-title":"Progressive aortic root dilatation in adults late after repair of tetralogy of Fallot","volume":"106","author":"Niwa","year":"2002","journal-title":"Circulation"},{"key":"B15","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1161\/CIRCULATIONAHA.112.129585","article-title":"Aortic root dilatation in adults with surgically repaired tetralogy of Fallot: a multicenter cross-sectional study","volume":"127","author":"Mongeon","year":"2013","journal-title":"Circulation"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1851997\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:10:32Z","timestamp":1787562632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1851997\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":15,"alternative-id":["10.3389\/fcvm.2026.1851997"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1851997","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1851997"}}