Pancycle Aortic Incompetence and Double Alternans in Pediatric Heart Failure

A 12?year?old boy presented with bicuspid aortic valve, severe aortic regurgitation, and dilated dysfunctional left ventricle in heart failure. He underwent aortic valve replacement with a 23 mm TTK Chitra heart valve prosthesis (tilting disk). He was gradually weaned off milrinone and noradrenaline in the intensive care. Echocardiography showed severe left ventricular dysfunction with an ejection fraction of 24%. The radial pulse was regular and of normal volume but exactly half that of the heart rate. Evaluation of the rhythm and echocardiography revealed an interesting hemodynamic phenomenon with double alternans.

Early and mid-term outcomes of aortic valvuloplasty in children / 中华实用儿科临床杂志

Objective:To analyze the short and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases.Methods:A total of 26 children with aortic valve diseases (stenosis or regurgitation) who underwent aortic valvuloplasty with autopericardium in Fuwai Central China Cardiovascular Hospital from September 2017 to June 2021 were retrospectively analyzed.The short-term and mid-term follow-up data were collected.The maximum aortic valve pressure gradient, subaortic regurgitation area, left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were compared before and after operation.Paired t test was used to analyze the short-term and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases. Results:All 26 cases were successfully operated, and there were no deaths and serious complications during the follow-up period of (22.96±6.45) months.There was a significant difference between the preoperative and postoperative maximum aortic valve pressure gradient at 1 month ( t=7.85, P<0.05), 6 months ( t=6.43, P<0.05), 1 year ( t=6.16, P<0.05) and 2 years postoperatively ( t=4.22, P<0.05) in children with aortic stenosis or that combined with mild-to-moderate closure.The follow-up data of 9 children with simple aortic stenosis showed that there was a significant difference between the preoperative (8.87±3.57) cm 2 and postoperative aortic regurgitation area at 1 month ( t=6.85, P<0.05), 6 months ( t=5.13, P<0.05), 1 year ( t=6.62, P<0.05) and 2 years postoperatively ( t=5.41, P<0.05). The LVEDV of 26 children was significantly lower at 6 months[(63.54±27.61) mL], 1 year [(53.61±20.20) mL] and 2 years postoperatively [(64.39±17.78) mL] compared with that of preoperative level[(89.42±45.89) mL]( t=3.89, 4.67, 3.58, all P<0.05). The left ventricular pressure and volume decreased, the enlarged heart was narrowed down, and the geometry of the heart was restored.The LVEF of 26 patients also from (61.65±9.67)% before surgery increased to (67.88±4.69)% 6 months after surgery( t=3.68, P<0.05), and increased to (68.62±4.46)% 1 year after surgery( t=4.01, P<0.05), and increased to (67.55±3.09)% 2 years after operation( t=3.01, P<0.05), and the heart function was improved. Conclusions:Aortic valvuloplasty with autopericardium presents an effective short and mid-term efficacy on children with aortic valve diseases, which prevents or delays the aortic valve replacement.

The clinical effect of a combined technical system for bicuspid aortic valves repair / 中国胸心血管外科临床杂志

@#Objective    To summarize the clinical result of a combined technical system for bicuspid aortic valve (BAV) repair. Methods    Patients who diagnosed as BAV and sever aortic regurgitation (AR) underwent a strategy of combined repair technics including annuloplasty, sinus plasty, leaflet plasty, sinus-tubular junction (STJ) plasty depending on anatomy pathological characteristics between October 2019 and January 2021 were enrolled. The clinical data of the patients were analyzed. Results    A total of 17 patients were enrolled. There were 11 males and 6 females with an average age of 18-49 (32.4±13.6) years. Fifteen patients had typeⅠand 2 patients had typeⅡBAV according to Sievers classification. Annuloplasty was applicated in 13 patients, sinus plasty in 8 patients, leaflet plasty in 17 patients, and STJ plasty in 11 patients, respectively. The cardiopulmonary bypass (CPB) time was 95 (84, 135) min, aortic cross-clamping time was 68 (57, 112) min, and the ICU stay time was 17 (12, 25) h. After the operation, mild AR was presented in 14 patients, moderate AR in 1 patient and severe AR in 2 patients. The latter 3 patients underwent second operation under CPB, after then, 1 patient had mild AR and 2 patients had moderate AR. The follow-up time was 13.1±4.6 months. At the latest follow-up, 12 patients had mild AR and 5 patients had moderate AR, and no patient had reoperation. Conclusion    A combined technical system for BAV repair can be used effectively and safely with an acceptable short and middle-term result.

Procedure specifications for transapical transcatheter aortic valve replacement / 中国胸心血管外科临床杂志

@#Transcatheter aortic valve replacement (TAVR) techniques have been rapidly developed in recent years. Current guidelines and studies mainly focus on aortic stenosis patients treated by transfemoral approach, but they are not completely appropriate to patients with isolated aortic regurgitation or other patients who need transapical TAVR (TA-TAVR), which affects the standardized treatment of those patients. Therefore, our team pronounced the operational standards for TA-TAVR, based on fully reviewing the literatures worldwide, combined with the opinions of experts from 15 heart centers with rich experience in carrying out TA-TAVR in China. This standard aims to provide clinicians with standardized diagnosis and treatment principles of TA-TAVR and improve the quality of TA-TAVR in China.

Transcatheter aortic valve replacement in pure native aortic regurgitation: when off-label indications match the patient's requirements / TAVI en IA pura de válvula nativa: cuando indicaciones fuera de guías cumplen los requerimientos del paciente

Abstract Objective: In recent years, transcatheter aortic valve replace (TAVR) has revolutionized the interventional treatment of aortic stenosis, however, only scarce evidence considers it as treatment for Aortic Regurgitation (AR). At present, the treatment of Pure AR of Native Valve with TAVR does not fall within the recommendations of international guidelines, as it poses multiple challenges with immediate and long-term variable and unpredictable results. The objective of this paper is to present the case of a patient with prohibitive operative risk that benefited of TAVR treatment for AR. Materials and methods: We present the case of a 79-year-old male patient who has severe Pure Native Aortic Valve Regurgitation, considered inoperable. Based on the heart team's decision, TAVR was planned with the use of an Edwards SAPIEN 3 valve. After TAVR, the patient developed complete heart block and a pacemaker was implanted. He improved to NYHA II functional class. At 15-month follow-up, he suffered intracranial hemorrhage and passed away. Results and Conclusions: Management of patients with severe symptomatic AR with high surgical risk continues to be a special challenge. They have high mortality if left untreated with valvular change, despite medical treatment. Even though it is strictly off-label, TAVR might be a reasonable solution for a select type of patients who are considered inoperable due to surgical high mortality risk.

Resumen Objetivo: En años recientes, el reemplazo valvular aórtico vía percutánea (TAVI) ha revolucionado el tratamiento de los pacientes con estenosis aórtica, sin embargo, poca evidencia la considera como opción de tratamiento en pacientes con insuficiencia aórtica (IA), especialmente en pacientes con Insuficiencia Aórtica Pura de Válvula Nativa (IAPVN), dado que esta patología confiere múltiples retos con resultados muy variables tanto a corto como a largo plazo. Dada su alta mortalidad en caso de permanecer sin tratamiento, la primera opción de tratamiento es la cirugía de cambio valvular. Material y Métodos: Presentamos el caso de un masculino de 79 años con IAPVN grave considerado inoperable dadas las comorbilidades. De acuerdo con la decisión del equipo de Cardiología, se decidió realizar TAVI con la colocación de una Válvula Edwards SAPIEN 3. El paciente desarrolló bloqueo AV completo como única complicación y se colocó marcapasos permanente. Permaneció en clase funcional NYHA II. A los 15 meses de seguimiento presentó hemorragia intracraneal y falleció. Resultados y Conclusiones: El manejo de los pacientes con IAPVN grave sintomática con riesgo quirúrgico alto sigue siendo un reto especial. Tienen alta mortalidad si no se realiza cambio valvular a pesar de tratamiento médico. A pesar de que no se recomienda en las guías actuales, la TAVI puede ser una opción razonable para un grupo muy selecto de pacientes que son considerados inoperables.

Aortic valve repair: An exciting journey / Reparación valvular aórtica: una experiencia emocionante

Abstract Aortic valve repair has become an attractive alternative to aortic valve replacement in most of the patients with aortic insufficiency. To improve reproducibility and durability "geometric anatomy" of the valve has been developed to guide the repair. Expert centers were able to publish remarkable short- and long-term results for aortic valve sparing procedures. Therefore, data comparing composite valve grafting and aortic valve sparing procedures revealed similar early mortality. Also, late mortality, thromboembolism, stroke and bleeding risks were significantly lower in patients undergoing aortic valve repair and late durability was equivalent1. However, the complexity of the procedures makes aortic valve repair difficult to be adopted into daily surgical practice. Accordingly, starting your own aortic valve repair program requires conviction, training, facilities, quality control and a well structured heart valve team to let your program succeed.

Resumen La reparación valvular aórtica se ha convertido en una alternativa atractiva al reemplazo, en la mayoría de pacientes con insuficiencia aórtica. Para mejorar la reproducibilidad y la durabilidad, se ha desarrollado una "anatomía geométrica" de la válvula para guiar la reparación. Los centros expertos han publicado resultados notables a corto y largo plazo en preservación valvular aórtica. Además, los estudios que compararon el cambio valvular por tubo valvulado con los procedimientos de preservación valvular, mostraron una mortalidad temprana similar, con riesgos de mortalidad tardía, como tromboembolia pulmonar, accidente cerebrovascular y hemorragia, significativamente menores en los pacientes sometidos a reparación valvular aórtica, con una durabilidad tardía equivalente1. Sin embargo, la complejidad de los procedimientos dificulta la adopción de la reparación valvular aórtica en la práctica diaria. En consecuencia, comenzar un programa de reparación valvular aórtica requiere convicción, capacitación, instalaciones, control de calidad y un equipo bien estructurado para que sea exitoso.

Remodeling+Ring (modified Yacoub) technique for the treatment of bicuspid aortic valve regurgitation with ascending aortic aneurysm: A case report / 中国胸心血管外科临床杂志

@#Patients with bicuspid aortic valve are often complicated with aortic dilatation. If the aortic valve is of good quality, aortic root replacement with aortic valve preservation is feasible. A 35-year-old male patient with bicuspid aortic regurgitation complicated with ascending aortic aneurysm underwent Remodeling+Ring (modified Yacoub) operation. Echocardiography showed that there was no aortic regurgitation on the 3rd day after operation, and the patient was discharged satisfactorily on the 6th day after operation. Remodeling+Ring surgery ensures the physiological movement of the aortic valve, solves the enlarged annulus, avoids the problems caused by valve replacement, and significantly improves the quality of life of patients, which is worth popularizing.

Transapical transcatheter aortic valve replacement using Ken-Valve for severe aortic stenosis combined with severe aortic regurgitation: A case report / 中国胸心血管外科临床杂志

@#Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. The use of new heart valves prosthesis has improved surgical safety and efficacy. This report described a 72-year-old male patient with severe aortic stenosis combined with severe aortic regurgitation, who was evaluated at moderate-high risk of surgery and received a transapical TAVR using the Ken-Valve heart valve. The transcatheter operation time was 8 min, and the blood loss was 50 mL. The tracheal intubation was removed immediately after the surgery. Transesophageal echocardiography on the 4th postoperative day showed that the aortic valve leaflets worked well, and there was no valve orifice and paravalvular leakage. The patient was discharged on the 5th day after the surgery without complications. Transapical TAVR using Ken-Valve was an easy surgical procedure for aortic valve disease, and had short operation time.

Transapical aortic valve implantation using J-Valve? system for high-risk patients with aortic regurgitation: mid-stage of 1 year follow-up / 中华胸心血管外科杂志

Objective:To analysis the mid-stage prognosis of transapical aortic valve implantation(TA-TAVI) using J-Valve? system for the treatment of high-risk aortic regurgitation(AR) patients.Methods:Data of 25 patients with aortic regurgitation who had underwent transapical aortic valve implantation using J-Valve? system were collected in the Second Affiliated Hospital of Medical College of ZheJiang University from September 2016 to June 2020 . Analysis and summarize their postoperative all-cause mortality, the incidence of adverse events and the improvement in cardiac function.Results:There were 25 patients, including 19 males, the age rage from 59-83 years, the average age was(72.3±27.11) years. The levels of aortic regurgitation was evaluated by transthoracic echocardiography preoperatively, showed that severe AR accounted for 88%. The New York Heart Association(NYHA) of grade 3 or above was 92%. The most common comorbidity was hypertension, accounted for 68%. Coronary heart disease and history of cardiac surgery was 5 and 3 relatively in this study. The Society of Thoracic Surgeons score before surgery was 1.511%-27.674%, the average of STS score was 4.27(2.914-6.033)%. Successful J-Valve implantation was obtained in all 25 cases, no conversion to thoracotomy. After surgery, 2 patients required permanent pacemaker implantation, 1 patient needed continuous renal replacement therapy(CRRT) due to acute kidney injury, 1 occurred moderate or above paravalvular leak. The results showed good therapeutic effects in early-stage, low incidences of adverse events. The continued improvement of cardiac function and ventricular reverse remodeling could be observed in mid-stage.Conclusion:In this study, we can summarize that high-risk patients with aortic regurgitation treated with transapical aortic valve implantation using J-Valve? system can acquire great perioperative safety and mid-stage prognosis.

Endocarditis infecciosa por Neisseria gonorroheae / Infectious endocarditis due to Neisseria gonorrhoeae

Resumen Se presenta un caso de endocarditis infecciosa por Neisseria gonorrhoeae, en un paciente masculino de 38 años, sin factores de riesgo cardiovascular ni otros antecedentes previos. La sospecha diagnóstica comienza por síndrome febril prolongado, astenia y pérdida de peso, confirmada con rescate de gonococo en los hemocultivos. Cumplió tratamiento antibiótico con ceftriaxona por 29 días. Evoluciona con insu ficiencia aórtica grave por lo cual se realiza cirugía de reemplazo valvular por prótesis mecánica bidisco exitosa, con una evolución favorable.

Abstract We report a case of infectious endocarditis due to Neisseria gonorrhoeae in a 38-year-old male patient with no cardiovascular risk factors or past medical history who presented with prolonged febrile illness, asthenia and weight loss. The blood cultures were positive for gonococcus. He received antibiotic treatment with ceftriaxone for 29 days. The patient developed severe aortic regurgitation and underwent surgical aortic valve replacement with a bileaflet mechanical prosthesis, with favorable outcome.

Aortic valve repair in adult patients with aortic regurgitation: the construction of a technics system and a short and mid-term result / 中华胸心血管外科杂志

Objective:To summarize the construction of a technics system of aortic valve repair in adult patients with aortic regurgitation(AR).Methods:From March 2013 to May 2020, aortic valve repair was performed in 79 patients. In which 43 cases underwent simple technics such as subcommissural annuloplasty, leaflet plication etc. Cases done before May, 2018 were defined as A group, yet the other 36 cases underwent a routine repair technics system including annuloplasty, sinusplasty, cuspidplasty and sinotubularplasty after then as B group. The general data and the operation procedure, also the follow-up were analyzed.Results:In group A, there were 2 cases with simple aortic valve repair and 41 cases with other intracardiac operations. In group B, 23 patients had aortic valve repair alone and 13 patients had other intracardiac operations. Group A mostly adopts the technologies of subjunctional involution and ridge suspension. In group B, flap ring molding, flap leaf molding, sinus tube joint molding and other technologies were used. Postoperative reflux was reduced to moderate or mild in most patients in group A. In group B, postoperative reflux was reduced to mild in most patients. There were 7 cases of severe reflux in group A, and 2 cases of severe reflux were worse after repair than before surgery. In group B, 8 patients had no effective repair, and 3 patients continued to have satisfactory repair after the second turnaround. Aortic regurgitation at 1 year(or the last echocardiographic follow-up) after surgery: 15 patients in group A were mild, 17 were moderate, and 4 were severe; In group B, 2 patients underwent revalve replacement within 1 year, and the remaining 29 patients were moderate and mild, 20 cases were moderate, 7 cases were moderate, and 2 cases were severe.Conclusion:In some adult moderate and severe AR cases, a routine combined repair system can be applied to increase success rate of repair, and shows a good short and mid-term result.

Gold in the dust: the re-evaluation of early surgical results of Ross procedure for aortic valve disease in children / 中华胸心血管外科杂志

Objective:To study the surgical results of Ross procedure in pediatric patients. We report our early outcomes of the Ross procedure for congenital aortic valve disease.Methods:Retrospective analysis was performed on all 16 children with congenital aortic valve disease that underwent a Ross procedure from May 2018 to December 2019. Three patients had aortic stenosis(AS), 5 had aortic regurgitation(AR), and 8 patients had AS/AR. Two patients had endocarditis. Nine patients had prior aortic valve surgeries or interventions, 7 had percutaneous balloon aortic valvuloplasty, 1 had surgical valvotomy and 1 had aortic valve repair by cusp extension. Six patients had bicuspid and 1 had quadricuspid aortic valves.Results:There was no early death. Mean CPB time was (193.8±66.9) min (range 123~359 min), mean aortic cross-clamping time was (125.9±29.7) (range 82-186 min). Mean ventilation time was (58.0±42.4) h (range 22.7-163.0 h), and mean ICU and hospital length of stay was (5.4±3.4) d (range 2-16 d) and (25.9±18.7) d (range 7-77d). Six patients developed low cardiac output syndrome and 2 patient had hepatic dysfunction, which all improved after treatment. Follow-up was complete in all patients from 3 to 23 months, and there was no late death. Thirteen patients were in NYHA grade Ⅰ, and 3 in grade Ⅱ. The peak gradients through the aortic valve and pulmonary valve were (8.3±5.5)mmHg (3.7-26.6mmHg) and (20.5±16.4) mmHg (6.8-62.1 mmHg), respectively. The aortic regurgitation was negative in 3 patients, trivial in 1 patient and mild in 12 patients. The pulmonary regurgitation was trivial in 4 patients, mild in 9 patients and moderate in 3 patients.Conclusion:Ross procedure is a safe, effective surgical operation for congenital aortic valve disease in children >1-year of age.

Mid-term result of valve-sparing root replacement in acute type A aortic dissection: comparison of reimplantation versus remodeling / 中华胸心血管外科杂志

Objective:To compare the mid-term result of two different valve-sparing root replacement techniques in acute type A aortic dissection: including reimplantation and remodeling.Methods:From March 2009 to December 2019, 41 patients with acute type A dissection and root involvement, who underwent a valve-sparing root replacement using reimplantation(36 cases) or remodeling(5 cases) were retrospectively analyzed in current study. The average age was(44.63±11.34) years old, 36 males. The differences of perioperative variables, postoperative aortic insufficiency and postoperative survival were compared between the two groups.Results:Thirty-day mortality for two groups was 2.8% and 20%( P=0.23). Remodeling group was significantly inferior to reimplantation group in terms of blood consumption(red blood cells, plasma and platelets), postoperative mechanical ventilation time, reoperation for bleeding and hemofiltration for acute renal failure. The median follow-up time of 39 discharged survivors was 34.56(3-121) months, and the follow-up rate was 100%. There was no follow-up death, no bleeding or embolism events, and no cardiovascular reoperation. Grade 2 or sever aortic regurgitation in remodeling group was significantly higher than that in reimplantation group( P=0.02). A Cox regression analysis identified that the remodeling technique was the independent risk factors of postoperative aortic regurgitation. Conclusion:Compared with remodeling technique, reimplantation technique has better perioperative and mid-term results in patients with acute type A aortic dissection. The rate of reoperation for bleeding, the blood consumption and the postoperative aortic regurgitation are significantly reduced. The long-term results need further follow-up.

Short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves / 中国胸心血管外科临床杂志

@#Objective    To evaluate the short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves (BAV). Methods    The clinical data of 27 consecutive patients with insufficient BAV undergoing valve repair in Shanghai Chest Hospital from September 2016 to January 2020 were retrospectively reviewed. There were 24 males and 3 females with a mean age of 38.5±14.6 years (range: 20-68 years). BAV of all patients was type 1 in Seviers' classification. There were 23 patients with left-right fusion and 4 patients with right-noncoronary fusion. There was aortic regurgitation in the patients measured by the echocardiogram, including moderate regurgitation in 3 patients, moderate-severe in 18 patients, and severe in 6 patients. The diameter of aortic annular base was 27.9±3.4 mm, and the largest diameter of aortic sinus was 39.9±7.6 mm. Left ventricular end diastolic diameter was 62.7±6.5 mm, and the volume was 197.9±53.6 mL. Results    All 27 patients completed the follow-up, and the mean time was 24.2±12.5 months (range: 12-51 months). No patient died or required aortic valve-related reoperation during the follow-up. The cardiac function of the patients significantly improved postoperatively (P<0.05). By echocardiography, 11 patients had no aortic regurgitation, 13 had mild aortic regurgitation, and 3 had moderate aortic regurgitation, and no patient had severe aortic regurgitation. Postoperative left ventricular end diastolic diameter and volume decreased, compared to preoperative ones (P<0.05). Conclusion    In patients with insufficient BAV, valve repair is safe and effective, and has excellent short and mid-term outcomes.

Nonspecific Inflammatory Aortic Regurgitation Diagnosed after Aortic Valve Replacement / 日本心臓血管外科学会雑誌

A case of clinical1y unsuspected nonspecific inflammatory aortic regurgitation is reported. A 69-year-old female patient underwent aortic valve replacement for aortic regurgitation. Pathological examination of resected aortic valve showed abscess formation and inflammatory granulation tissue in the non-coronary cusp. Therefore, we diagnosed nonspecific inflammatory aortic regurgitation. It is generally considered that the use of prednisolone for vasculitis syndrome is effective ; however, for nonspecific inflammatory aortic regurgitation its use has not been established. Prednisolone treatment could be an option for nonspecific inflammatory aortic regurgitation.

Risk factors for 24-hour death in acute type A aortic dissection patients with conservative treatment / 中国胸心血管外科临床杂志

@#Objective    To explore the risk factors for 24-hour death in acute type A aortic dissection (ATAAD) patients with conservative treatment. Methods    From January 2009 to January 2018, 243 ATAAD patients who received non-surgical intervention were admitted in Beijing Anzhen Hospital, including 167 males and 76 females with an average age of 53.0±12.0 years. The risk factors for 24-hour mortality were analyzed. Results    The total in-hospital mortality rate was 37.9% (93/243), and 13.6% (33/243) patients died within 24 hours of onset. We found that left ventricular end diastolic diameter [LVEDD, OR=0.45, 95%CI (0.25, 0.83), P<0.01] and aortic regurgitation [OR=7.26, 95%CI (1.67, 31.53), P<0.01] were independent risk factors for 24-hour death in patients with ATAAD. Conclusion    In this study, LVEDD and aortic regurgitation are identified as independent risk factors for 24-hour mortality in ATAAD patients. Therefore, patients with aortic regurgitation and small LVEDD should be treated with sugery as soon as possible.

A Case of Giant Unruptured Left Coronary Sinus of Valsalva Aneurysm / 日本心臓血管外科学会雑誌

We herein report a rare case of unruptured, giant left coronary sinus of Valsalva aneurysm and discuss surgical pitfalls associated with sinus of Valsalva aneurysms. A 63-year-old man was referred to us for clinical diagnosis and surgical treatment of a huge mass in the mediastinum. Enhanced computed tomography (CT) imaging revealed that the mass was a left coronary sinus of Valsalva aneurysm with a diameter of 74×57 mm ; moreover, the left coronary artery originated from the aneurysmal wall. In addition, echocardiography showed moderate aortic regurgitation (AR) caused by dilatation of the aortic annulus. Based on these findings, the Bentall procedure was selected for the Valsalva aneurysm and significant AR. The orifice of the aneurysm was 15×15 mm in size, and the aortic wall of the left coronary sinus was relatively thin. The left main trunk was injured due to severe adhesion between the trunk and the aneurysm ; therefore, vein patch repair was performed with a saphenous vein graft. Since the aortic annulus of the left coronary cusp was fragile, proximal anastomosis of the composite graft to the lesion had to be placed in the fibrous continuity between the aortic and mitral valves. With respect to the proximal anastomosis at the aortic annulus of the left coronary cusp, the suture line was covered with a bovine pericardium patch as there were no remnants of the normal aortic wall. The postoperative course was uneventful, and postoperative CT revealed complete resection of the aneurysm with no evidence of stenosis of the left main trunk.

Rotura aguda de prótesis valvular aórtica biológica Biocor® seis años después de su implante: reporte de un caso / Acute rupture a a Biocor® aortic valve prosthesis six years after implantation

Resumen: Un hombre de 66 años portador de una prótesis valvular aórtica SJM Biocor® (Saint Jude Medical, St Paul, Minn), instalada 6 años antes, se presentó con disnea severa de rápida instalación. Mediante ecocardiografía de superficie y transesofágica se demostró insuficiencia aórtica masiva y el paciente fue reintervenido con éxito. En la operación se observó un desprendimiento parcial de la inserción del velo coronario izquierdo al anillo protésico. No había endocarditis. Se implantó una nueva prótesis biológica Trifecta® (Saint Jude Inc, St Paul, Minn) N°27. La evolución precoz y a 2 años de la intervención es muy satisfactoria.

Abstract A 66 year-old man with a SJM Biocor® (Saint Jude Medical, St Paul, Minn) implanted 6 years before developed unexpected severe dyspnea. Surface and transesophageal echocardiograms confirmed severe aortic regurgitation. The patient was rapidly re operated on. There was a partial detachment of the left coronary leaflet form the valve annulus. There was no evidence of endocarditis. A new valve (Trifecta® (Saint Jude Inc, St Paul, Minn) N°27). was inserted. Clinical course has been uneventful up to two years post surgery.