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No abstract

An 87-year-old woman underwent AVR (CEP 21 mm) for aortic stenosis at age 73 years. Fourteen years later, she was treated with antibiotics for mediastinal abscess, which showed a tendency to shrink and inflammation improved. At that time, no vegetation or aortic regurgitation was observed. Eight months later, the patient was brought to the emergency room with a complaint of respiratory distress. After close examination, a severe transvalvular leakage was found at the aortic valve position. No vegetation was found. Enhanced chest computed tomography (CT) showed an aneurysm of the left sinus of Valsalva. The diagnosis of healed aortic prosthetic valve endocarditis with an aneurysm of the sinus of Valsalva was made. The CEP valve was removed at surgery, and the valve leaflet corresponding to the right coronary cusp was destroyed. The left sinus of Valsalva was dilated and a Perceval was implanted. The patient was doing well postoperatively, but a pacemaker was implanted due to atrioventricular dissection. Transthoracic echocardiography confirmed that there was no problem with prosthetic valve function at the aortic valve position, and CT showed a reduction of aneurysm of the left sinus of Valsalva. The patient was discharged from the hospital on the 30th postoperative day. Aortic valve replacement with Perceval is effective in high-risk cases of prosthetic valve endocarditis.

A 63-year-old woman presented with chest discomfort. Coronary angiography revealed vasospastic angina. Cardiac multi detector computed tomography and cardiac magnetic resonance imaging showed a 30 × 30-mm atrial septal aneurysm (ASA) protruding into the right atrium and thrombus attached to the left side of the ASA pouch. We surgically resected the ASA because the patient was at risk for systemic thrombosis. The resection site was closed with pericardial patch through a median sternotomy under a cardiopulmonary bypass. The postoperative course was uneventful, and the patient was discharged on postoperative day 26.