Aortic Valve Repair for an Aortic Valve Periprosthetic Leakage

(Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Japan)

Taishi Fujii Tamaki Takano Megumi Fuke
Kazunoki Komatsu Kazuyoshi Otu Takamitsu Terasaki
Yuko Wada Daisuke Fukui Jun Amano
A 77-year-old man underwent aortic valve replacement with a Carpentier-Edwards Pericardial Magna(19mm)for aortic stenosis. He presented with a low grade fever and congestive heart failure 6 months after the initial valve replacement. Staphylococcus aureus was detected in blood culture, and peri-valvular leakage was revealed by echocardiography. Prosthetic valve endocarditis was diagnosed and underwent re-aortic valve replacement with Medtronic Mosaic 21mm bioprothesis. Six months after the re-do operation, perivalvular leakage was newly observed between the right and non-coronary cusps, which was opposite to endocarditis affected cusps. The peri-valvular leakage was considered to have resulted from the fragile valve annulus because he did not have fever, and repeated blood culture showed no bacterial growth. We performed a third surgery and repaired the leakage by adding sutures through the right atrium and the interventricular septum to avoid directly suturing the fragile annulus. The post-operative course was uncomplicated, and no sign of endocarditis nor perivalvular leakage was observed during 9-months of observation. It is considered that the aortic valve fixation sutures through the right atrium and inter-ventricular septum are useful alternatives for fragile aortic annulus after prosthetic valve endocarditis.
  Jpn. J. Cardiovasc. Surg. 41:262-265(2012)

Keywords:perivalvular leakage, repair, endocarditis