RESUMO
The patient was a 57-year-old man who, in 1973, at 19 years of age, had undergone mitral valve replacement for mitral valve stenosis using a Björk-Shiley Delrin (BSD) valve. When the patient visited our hospital, he was living in an assisted-living facility due to paresis of the right side of the body, dysarthria, and other sequelae of cerebral infarction. The patient was referred to and visited our hospital with a chief complaint of chest pain in 2011, 38 years after the BSD valve was implanted. In 2012, mitral valve re-replacement, aortic valve replacement, and tricuspid annuloplasty were performed for congestive heart failure associated with prosthetic valve failure, combined aortic stenosis and insufficiency, and tricuspid insufficiency, which were identified by transesophageal echocardiography. The patient's postoperative course was generally favorable. The disc of the resected prosthetic valve showed a groove and bidirectional cracks caused by wear, and its condition suggested a risk of potential rupture. Transthoracic echocardiography on admission showed mild to moderate prosthetic transvalvular regurgitation, and the symptoms were therefore unlikely to have resulted from the prosthetic valve failure alone at this time. Consequently, it was considered that the heart failure was attributed to the prosthetic transvalvular regurgitation caused by the disc abnormalities in addition to the combined valvular disease by transesophageal echocardiography. In this case, detailed investigation of the heart failure by transesophageal echocardiography led to the discovery of prosthetic valve abnormalities, thus enabling the prevention of a serious cardiac accident due to disc rupture. Detailed examination by transesophageal echocardiography is essential, and early surgical intervention should also be considered if transthoracic echocardiography suggests even a minor prosthetic valve abnormality in a patient who has had this prosthetic valve implanted for such a long time.
RESUMO
Reconstruction of the right ventriclar outflow tract (RVOT) in congenital heart disease often requires implantation of a valved conduit. A hand-made expanded polytetrafluoroethylene (ePTFE) trileaflet Dacron graft conduit has been used at our center since 1997, and has been implanted in 31 patients. Midterm results of this conduit were investigated in 30 of the patients who have been followed at our outpatient clinic. There were 16 males and 14 females. The mean age and body weight were 16.4±7.2 (range, 3.4-33.4) years and 41.7±13.3 (range, 13.0-64.0)kg, respectively. Diagnoses were tetralogy of Fallot with pulmonary atresia in 14 patients, RVOT reconstruction associated with Ross procedure in 8, transposition with pulmonary stenosis in 3, pulmonary atresia with intact ventricular septum in 2, tetralogy with absent pulmonary valve syndrome in 1, pulmonary regurgitation developed after tetralogy repair in 1, and hemitruncus in 1. The median size of the graft was 22 (range, 20-26)mm. All patients were in NYHA functional class I at the time of the latest follow-up. The pressure gradient across the conduit was 11.0±5.8mmHg during the same hospitalization and 13.8±6.5mmHg on the latest echocardiogram (Interval, 2.4±1.5 years, <i>p</i>=0.85). The valve function was well maintained in all patients, with the regurgitation graded as non-trivial in 22 patients, mild in 7, and moderate in only 1. Midterm results of hand-made ePTFE trileaflet valved cunduit was satisfactory. A longer follow-up is mandatory to assess its actual durability.