ABSTRACT
A 44-year-old man presented with syncope and complete A-V block on electrocardiogram. Echocardiography revealed vegetation attached to the aortic, mitral and tricuspid valves. He underwent surgical repair because of uncontrollable congestive heart failure. The vegetation was attached to the noncoronary cusp entirely and had developed to the anterior mitral leaflet. The noncoronary sinus of Valsalva formed a giant mycotic aneurysm toward the right atrium and the aneurysm involved the tricuspid valve. The vegetation was resected together with the aortic valve and the aneurysm. Debridement was performed extensively on the right atrial wall and the aortic root. After closure of the orifice of the aneurysm with a bovine pericardium, aortic valve replacement was performed concomitantly with aortic annular reconstruction using a Hemashield<sup>®</sup> graft. Valvuloplasty was performed on the mitral and tricuspid valves. The technique described above enabled us to resect the infectious focus and successfully repair the defective tissues.