Novel Use of the Perceval Valve for Prosthetic Aortic Valve Endocarditis Requiring Root Replacement

The surgical management of aortic valve endocarditis can be challenging. Infection with abscess formation can destroy the root and annulus, making it difficult to anchor a valve conduit. In this article, we present a novel and efficient strategy for proximal aortic reconstruction. We used a Dacron tube graft and anchored it proximally with a running suture line deep in the left ventricular outflow tract. The coronary buttons were attached, and a Perceval valve was then deployed inside the neo-root to create a bio-Bentall.

Challenging Cases of Aortic Prosthesis Dysfunction, the Importance of Multimodality Imaging, a Case Series

ECG-gated multidetector computed tomography (MDCT) is a promising complementary technique for evaluation of cardiac native and prosthetic structures. MDCT is able to provide a broader coverage with faster scan acquisition times that yield higher spatial and temporal resolution for cardiac structures whose quality may be affected by artifacts on ultrasound. We report a case series about the most challenging complications occurring after prosthetic aortic valve implantation in four patients: pannus, paravalvular leak, prosthesis’ misfolding and subaortic membrane reformation. In all the cases, enhanced MDCT using a retrospective protocol provided accurate 3D morphoanatomic information about cardiac and extracardiac structures, improving and speeding up the correct diagnosis and treatment planning. Integrated imaging, in particular with MDCT, is now the present, and it will increasingly be the future in the assessment of cardiac structural pathology.

BALLOON VALVULOPLASTY FOR EARLY BIOPROSTHETIC AORTIC VALVE STENOSIS IN SEPTUAGENARIAN - A RAY OF HOPE

Calcic aortic stenosis (AS) remains a major cause of mortality and morbidity in the aging population . Surgical AV Replacement (SAVR) and Transfemoral Aortic Valve Implantation (TAVI) are available treatment options. With improvements in long term patient survival after AVR and increases in overall longevity, more patients are now seen with Prosthetic Aortic Valve failure. The management of patients with stenotic aortic bioprostheses is usually surgical. However, a proportion of such patients are unt for such procedures. The technique of aortic balloon valvuloplasty as an alternative treatment strategy for such patients is explored. We report a case of seventy-three-year-old male with prosthetic aortic valve stenosis treated with balloon valvuloplasty with promising intermediate term outcome and describe the growing valve in valve procedure. Hence this case is reported to enhance our knowledge and potentiate literature regarding the management strategy of prosthetic aortic valve stenosis in old age.

Outcome of Pulmonary Autograft After the Ross Procedure

Background: The purpose of this study was to assess autograft function after the Ross procedure and to review surgical outcomes associated with autograft reoperations. Methods: This is a retrospective study of patients undergoing the Ross procedure since 1993. Autograft function and autograft reoperation were studied. Autograft failure was defined as more than moderate autograft regurgitation or autograft dilatation to more than 50 mm diameter or z-score of more than +4 in children. One hospital death was excluded from analysis as were patients with unknown late autograft status. Results: Among 75 patients analyzed, preoperative diagnosis before the Ross procedure included aortic regurgitation in 26, aortic stenosis in 19, combined lesions in 28, and 2 mechanical valve malfunctions. Median age at the Ross procedure was 12.1 (0.4-43.6) years with 44 children less than 15 years old. Six patients had greater than mild autograft regurgitation at post-Ross hospital discharge. During median follow-up of 14.9 years, there were 23 autograft failures. Eighteen autograft reoperations were performed on 17 patients (13 children), including 12 aortic valve replacements, 5 aortic root replacements (including 1 valve-sparing root replacement), and 1 Konno procedure. Freedom from autograft failure and autograft reoperation at 20 years after the Ross procedure was 52.0% and 66.3%, respectively. Multivariate analysis identified greater than mild autograft regurgitation at hospital discharge from Ross procedure as a risk factor for autograft failure ( P < .01). All patients who underwent autograft reoperation survived and had good health status at a median of 6.9 years after the reoperation. Conclusions: The Ross procedure is effective in delaying prosthetic aortic valve replacement, although the time-related risk of autograft failure is a real consideration.

Coronary embolism due to possible thrombosis of prosthetic aortic valve - the role of optical coherence tomography: case report

Background Coronary embolism is an important non-atherosclerotic cause of acute myocardial infarction (AMI) that requires an individualized diagnostic and therapeutic approach. Although certain angiographic criteria exist that render an embolic origin likely, uncertainty remains. Optical coherence tomography (OCT) is a high-resolution intracoronary imaging technology that enables visualization of thrombus and the underlying coronary vessel wall, which may be helpful to distinguish between an atherosclerotic and non-atherosclerotic origin of AMI. Case summary A 50-year-old male was admitted with ongoing chest pain. Eleven years ago, he underwent implantation of a mechanical aortic valve prosthesis due to degenerated bicuspid valve with normal coronaries on preoperative angiography. The electrocardiogram showed anterior ST-segment elevation. Emergent angiography revealed total occlusion of the proximal left anterior descending artery (LAD). Thrombus was aspirated along with administration of intravenous glycoprotein IIbIIIa inhibitor. Except the apical part of the LAD showing distal embolization, coronary flow was completely re-established with no evidence of significant atherosclerosis. Stents were not implanted on the basis of the OCT finding, which demonstrated at the site of occlusion a normal vessel wall without atherosclerosis that could explain an erosion or plaque rupture event. Transoesophageal echocardiography confirmed a floating structure in the left ventricular outflow tract, suggesting that an embolus originating from the prosthetic aortic valve obstructed the LAD. The international normalized ratio 2 days prior to presentation measured 1.9. Discussion This case illustrates the utility of OCT to rule out the atherosclerotic aetiology of myocardial infarction and to avoid unnecessary stenting.