This is the first reported case of a self-expanding aortic valve explanted from the ascending aorta consisting of a Dacron prosthesis. We describe a 75-year-old male with bicuspid aortic valve regurgitation initially treated with a David procedure. Following degeneration, a “valve-in-repaired-valve” transcatheter aortic valve implantation (TAVI) was performed. Six years later, he presented with dyspnea, severe insufficiency, and paravalvular leakage. An interdisciplinary team opted for redo surgery. The patient underwent successful redo aortic valve replacement with an EpicMax bioprosthesis via resternotomy. Despite a complex postoperative course, he recovered well. This case underscores key challenges in lifetime management, including TAVI durability, sizing, and reoperative strategies.
Background:Heterotaxy with abdominal situs inversus complicates cardiac surgery due to mirror-image anatomy and associated venous anomalies. Case Description:A 61-year-old woman with heterotaxy, abdominal situs inversus, atrial fibrillation, and prior dual-chamber cardiac pacemaker implantation presented with New York Heart Association class III dyspnea and severe secondary mitral and tricuspid regurgitation. Preoperative imaging revealed a narrow left-sided inferior vena cava and persistent left superior vena cava. Minimally invasive multivalvular repair via right minithoracotomy was successfully performed using dual-site venous drainage. Conclusion:Tailored venous drainage based on detailed preoperative imaging enables safe minimally invasive surgery in patients with complex venous anatomy.
Background Metal hypersensitivity represents a rare but important challenge in cardiothoracic surgery, particularly during prosthesis selection for aortic valve replacement. Case Description A 63-year-old woman with critical bicuspid aortic stenosis and moderate left ventricular dysfunction was found to have severe hypersensitivity to multiple metal alloys, including nickel, palladium, and iridium. Following multidisciplinary evaluation, standard surgical aortic valve replacement was considered unsafe. A transfemoral transcatheter aortic valve implantation using a cobalt-chromium transcatheter valve was successfully performed without complications. Conclusion This case highlights the importance of individualized, multidisciplinary decision-making when managing patients with significant metal hypersensitivity.
This case report describes a 23-year-old male with a history of bicuspid aortic valve endocarditis managed with an emergency Ross procedure in 2020, whereby a xenograft pulmonary conduit prosthesis was implanted in the pulmonary position, followed by pulmonary conduit stenosis treated initially with high-pressure balloon dilatation 3 years later. The consequent diagnosis of iatrogenic aortopulmonary (AP) window, combined with severe recurrent pulmonary conduit stenosis, necessitated reoperation with right ventricle-to-pulmonary artery homograft replacement and repair of the AP shunt.
Background:Redo aortic interventions after failed transcatheter aortic valve replacement (TAVR) are challenging, particularly with low coronary heights and dense frame ingrowth. Case Description:An 83-year-old woman with prior TAVR developed severe prosthetic stenosis. Surgical Resection of Prosthetic Valve Leaflets Under Direct Vision (SURPLUS) with implantation of a balloon-expandable aortic valve and intraoperative low-dose indocyanine green (ICG) near-infrared (NIR) angiography was performed. Real-time NIR imaging confirmed symmetric coronary opacification. The valve was well seated with improved ejection fraction (60-65%), and recovery was uneventful. Conclusion:SURPLUS with ICG-NIR angiography ensured coronary patency and safe hemodynamic restoration.
