Dissection of atrial septum after mitral valve replacement.

We report a patient who presented with paraprosthetic leak complicated by dissection of the interatrial septum after mitral valve replacement. A review of the literature provides confirmation that only 3 cases have been previously reported of this potential, albeit extremely rare, complication of prosthetic mitral valve replacement. Prosthesis oversizing and improper mitral annular handling appeared to be the predisposing factors of this complication.

Combined mitral and tricuspid valve repair in acute infective endocarditis.

Combined repair of the mitral and tricuspid valves involved with acute infective endocarditis was carried out in a 38-year-old drug addict. Mitral valve repair included vegetectomy, closure of posterior leaflet perforation, and posterior annuloplasty with a patch and a strip of glutaraldehyde-tanned autologous pericardium, respectively, while the tricuspid valve was reconstructed with the use of artificial chordae and valve bicuspidalization. At five months follow up the patient is asymptomatic, with echocardiographic evidence of only trivial mitral and tricuspid incompetence, and no signs of recurrent infection. This case report supports the use of valve reconstruction as a valuable option in patients in whom there is simultaneous involvement of the mitral and tricuspid valves with infective endocarditis.

Valve-related complications in elderly patients with biological and mechanical aortic valves.

BACKGROUND: Controversy still exists about the choice of aortic prosthesis in elderly patients. This study investigates valve- and anticoagulant-related morbidity and mortality in elderly patients after aortic valve replacement (AVR) with a biologic (BP) or mechanical prosthesis (MP). METHODS: Between 1981 and 1995, 355 consecutive patients aged 70 years or older (mean, 74+/-4 years; range, 70 to 87 years) underwent isolated AVR. There were 222 (63%) replacements with an MP and 133 (37%) with a BP. Mean follow-up was 3.7+/-2.8 years (range, 3 months to 15 years), with a total follow-up of 1,214 patient-years. RESULTS: Hospital mortality was 7.6% (27 of 355), decreasing to 4.6% in the last 3 years. There were 55 late deaths, 33 in patients with MP and 22 in those with BP. At 10 years there was no significant difference between MP and BP recipients in the actuarial estimates of survival (51%+/-8% versus 33%+/-13%), freedom from valve-related death (82%+/-7% versus 72%+/-12%), and freedom from thromboembolism (84%+/-7% versus 94%+/-3%). In contrast, 10-year freedom from anticoagulant-related hemorrhages was 74%+/-8% for MP and 99%+/-1% for BP (p = 0.02). Only 1 structural deterioration occurred, in a patient with BP. CONCLUSIONS: Satisfactory early results can be obtained in elderly patients after AVR with both MP and BP. The comparable low late survival in the two groups was predominantly influenced by non-valve-related deaths. A higher incidence of anticoagulant-related hemorrhages limits the use of MP in elderly patients. Thus, in this population, BP should be preferred not just on the basis of their expected longer durability, but mainly to avoid the risk of anticoagulant-related hemorrhages.

Quadricuspid aortic valve.

A quadricuspid aortic valve was observed in a patient requiring aortic valve replacement because of severe aortic regurgitation, while in another it was accidentally detected by means of transesophageal echocardiography performed during coronary artery bypass grafting. This report discusses the apparent rarity of this malformation and stresses the need for periodical controls in patients known to have a quadricuspid aortic valve.