ABSTRACT
A 56-year-old woman who had suffered from both aortic and mitral valve stenosis and regurgitation was treated by replacement of valves with 23 mm and 27 mm Björk-Shiley valves respectively. After weaning from cardiopulmonary bypass, the arterial systolic pressure rose to 100 mmHg but the diastolic pressure fell to 40 to 50 mmHg. Studies including transesophageal echocardiogram and fluoroscopy during operation revealed the valves functioning normally. Because low diastolic pressure and low cardiac output continued during postoperative period, fluoroscopy was carried out again. It showed incomplete diastolic closure of the disc of the prosthetic aortic valve. The emergency operation was performed. At reoperation, it was found that one of the end of suture knots located between the valve ring and the disc prevented the occluder from seating completely and caused aortic regurgitation. The suture end was cut shorter and the prosthesis within the sewing ring was rotated so that the occluder was kept away from the suture end.
Subject(s)
Aortic Valve Insufficiency/surgery , Heart Valve Prosthesis , Sutures , Aortic Valve , Aortic Valve Insufficiency/etiology , Aortic Valve Stenosis/surgery , Cardiac Output, Low/etiology , Female , Fluoroscopy , Humans , Middle Aged , Mitral Valve , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/surgery , Prosthesis Failure , ReoperationABSTRACT
A case of a 13 year-old girl with abdominal aortic obstruction is presented. At the age of nine years she underwent an evaluation for a continuous murmur heard over the left costal margin. The blood pressure was 210/125 mmHg in the ascending aorta, and an aortography revealed a critical stenosis in the descending aorta proximal to the origin of the celiac artery. No surgical treatment was recommended at this time. At the age of 13 years she developed severe headache and was admitted for the second time. Upon catheterization the ascending aortic pressure was 242/150 mmHg, and an aortography revealed total obstruction of the abdominal aorta in the segment proximal to the celiac artery. An extraanatomical bypass was constructed between the right axillary artery and the right common iliac iliac artery with a 10 mm dacron graft. Two weeks after this procedure, the blood systolic pressure was 110 mmHg in the upper extremities. It has been 12 months since the patient had this procedure, and she continue to do well, i.e., she has no particular limitations of the hip joint movement, has no headache, and remains to be normotensive.
