Acute Stenosis Of Porcine Stentless Bioprosthesis Caused By Infective Endocarditis

HomeCirculationVol. 114, No. 19Acute Stenosis of Porcine Stentless Bioprosthesis Caused by Infective Endocarditis Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBAcute Stenosis of Porcine Stentless Bioprosthesis Caused by Infective Endocarditis Tsuyoshi Taketani, Kan Nawata, Noboru Motomura, Minoru Ono and Shinichi Takamoto Tsuyoshi TaketaniTsuyoshi Taketani From the Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan. Search for more papers by this author , Kan NawataKan Nawata From the Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan. Search for more papers by this author , Noboru MotomuraNoboru Motomura From the Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan. Search for more papers by this author , Minoru OnoMinoru Ono From the Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan. Search for more papers by this author and Shinichi TakamotoShinichi Takamoto From the Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan. Search for more papers by this author Originally published7 Nov 2006https://doi.org/10.1161/CIRCULATIONAHA.106.621813Circulation. 2006;114:e567–e568A 54-year-old man who underwent aortic valve replacement with a Prima Plus stentless bioprosthesis (Edwards Lifesciences, Irvine, Calif) with the use of a subcoronary technique 4 months previously was referred to our hospital with prosthetic valve endocarditis. Clinical symptoms and laboratory test data had been improving since the patient began antibiotic treatment; however, inflammatory markers remained, and blood cultures were positive for coagulase-negative staphylococci. Echocardiography revealed multiple vegetations on the prosthesis and a partial detachment of its proximal suture line (Movie I), but there was no aortic regurgitation because the distal suture line was intact and valve functions were well maintained. We decided to continue antibiotic therapy and perform surgery after the inflammation subsided. On the 5th day of hospitalization, the patient went into sudden cardiac arrest; he was given cardiopulmonary resuscitation, and a transesophageal echocardiographic examination was performed. The images in Figure 1 show long- and short-axis views of the left ventricular outflow in the diastolic (A and B) and systolic (C and D) phases. The posterior half of the proximal suture line was dehisced, causing it to thrust into the left ventricular outflow tract in systole and thereby causing severe stenosis; there was no aortic regurgitation in diastole. The transvalvular maximum pressure gradient was 125 mm Hg. A fully animated version of the process represented in Figure 1 can be viewed in the Movie II. Despite intensive support with the percutaneous cardiopulmonary support system, the patient died of multiorgan failure. The autopsy revealed multiple vegetations on the prosthesis, and the posterior half of the proximal suture was detached (Figure 2). Although this is a very rare case, stentless valves may cause acute stenosis because of their flexibility if prosthetic valve endocarditis occurs, whereas aortic regurgitation is the usual form of presentation with stented valves. Download figureDownload PowerPointFigure 1. A and B, Long- and short-axis views of the prosthetic aortic valve in diastole.Arrowheads show the intact distal anastomosis; arrows show the detached proximal edge of the prosthesis. Aortic regurgitation is not present. C and D, Corresponding views in systole. The valve orifice is significantly narrowed by a flapping motion of the proximal edge of the prosthesis. The ascending aorta was replaced concomitantly during valve surgery. TEE indicates transesophageal echocardiography.Download figureDownload PowerPointFigure 2. Prosthesis viewed from the aorta (A) and left ventricle (B) at autopsy. Multiple vegetations were found on valvular leaflets, and the proximal suture was dehisced half-circumferentially (arrowheads). AML indicates anterior mitral leaflet.The online-only Data Supplement, which contains 2 movies, is available with this article at http://circ.ahajournals.org/cgi/content/full/114/19/e567/DC1.DisclosuresNone.FootnotesCorrespondence to Dr Tsuyoshi Taketani, Department of Cardiothoracic Surgery, The University of Tokyo, 7–3–1, Hongo, Tokyo 113–8655, Japan. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetails November 7, 2006Vol 114, Issue 19 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.621813PMID: 17088466 Originally publishedNovember 7, 2006 PDF download Advertisement SubjectsCardiovascular SurgeryEchocardiography