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SOLO SMART is a stentless bioprosthesis that comprises a larger effective orifice area and reduced pressure gradient, exhibiting a better hemodynamic profile than a stented bioprostheses. Currently, SOLO SMART finds application in patients with aortic valve diseases. However, patients with bicuspid aortic valve disease may present Valsalva sinus asymmetry. Recently, some studies have considered SOLO bioprosthesis as contraindicated in patients with a bicuspid aortic valve. Here, we report the case of a 79-year-old female with bicuspid aortic stenosis and Valsalva sinus asymmetry. We preoperatively assessed the aortic root of the patient using a novel 3D workstation that creates virtual reality VR images from cardiac CT data. After creating three symmetric commissures at the wall of the Valsalva sinus, we evaluated the distance from the coronary orifices. We determined the appropriate suture line of bioprosthesis avoid coronary orifice occlusion. Aortic valve replacement with SOLO SMART was successful, and the postoperative clinical course was uneventful. Hence, preoperative evaluation of the aortic root using VR images could be a precise and useful method for the assessment of the operative indication for SOLO SMART. Jpn. J. Cardiovasc. Surg. 47 : 267 271 2018 stentless bioprosthesis ; aortic valve replacement ; bicuspid aortic valve ; sinus of Valsalva ; virtual reality 76 2016 11

A 60-year-old man was referred to the emergency room of our hospital with back pain. During examination, he suffered a cardiopulmonary arrest. Suspecting acute coronary artery syndrome, emergency coronary angiography was performed. During percutaneous coronary intervention to the proximal left circumflex artery, cardiac tamponade occurred, and the patient was transferred to the operating room for an emergency repair of a left ventricular rupture. Before closing his chest, a Temporary Epicardial Pacing Wire (TEPW) was placed on the right ventricle. This wire was cut flush with the skin surface on postoperative day 7. On POD 28, the patient experienced an inflammatory reaction, and on POD 30, computed tomography revealed that this TEPW had migrated into the pulmonary artery. Under fluoroscopic guidance, the wire was extracted from the right ventricle and pulmonary artery using a gooseneck snare. After extraction, the patient's recovery was uneventful.