Aortic Root Replacement Using Composite Grafts for Prosthesis-Patient Mismatch after Aortic Valve Replacement with the Björk-Shiley Monostrut Valve 27 Years Ago : a Case Report

Abstract

We encountered a case of aortic root replacement of a prosthesis-patient mismatch PPM after performing aortic valve replacement AVR with the Björk-Shiley Monostrut BSM valve. The patient was a 55-year-old female. She underwent AVR with a bioprosthesis for the treatment of congenital aortic stenosis at 20 years of age ; AVR was performed again using the BSM valve at 28 years of age. Congestive heart failure gradually worsened, and she was referred to our hospital at 55 years of age, where she was diagnosed with PPM after AVR. Under general anesthesia, standard median resternotomy was performed, and cardiopulmonary bypass was established with right femoral artery and right femoral vein cannulation. Cardiac arrest was achieved with the antegrade application of a cold, crystalloid, cardioplegic solution. The BSM valve was removed, and her annulus was extremely small, measuring less than 19 mm. We performed an aortic root replacement with a 21 mm mechanical valve composite graft because aortic root enlargement was difficult owing to the fragility of her annulus and very severe adhesion surrounding the ascending aorta. The postoperative course was uneventful. Postoperative ultrasonic echocardiography showed reduced transvalvular mean gradients. Although the BSM valve is durable, non-structural valvular deterioration surrounding the implanted BSM valve may occur and should be monitored.