In this case surgical therapy should be considered immediately. The outcome of surgical repair is not depending on the implanted prosthesis, but solely on timing of the operation.

Fixation of smaller sewing cuffs of mechanical valve prostheses with a critically exposed fixation suture at the ventricular side of the prosthesis represents a significant risk for disruption during the implantation process through cut off by chance. We recommend meticulous inspection of the sewing cuff for signs of disruption before seating the valve into position. During follow-up particular attention should be paid to valve dislodgement and leakage. The company was informed and advised by us to modify the fixation of the prosthetic annulus of the SJM((R)) Regent valve, which has led to an alternative cuff design, called the SJM Flex cuff.

A congenital defect of the right coronary leaflet (fenestration) is an unusually rare cause for aortic incompetence in childhood. We report an eight-year-old child with such an anomaly who presented with infective endocarditis of the left ventricle. The importance of excision of the vegetation prior to the occurrence of lifethreatening embolic complications is discussed.