Spontaneous Tear in the Noncoronary Cusp of the Medtronic Freestyle Bioprosthesis

Abstract

A 68-year-old male was admitted with heart failure three years following the insertion of a Freestyle stentless bioprosthesis (Medtronic, Inc., Minneapolis, MN, USA) to replace the aortic valve and root along with a Gelweave woven polyester graft (Vascutek Terumo, Renfrewshire, Scotland, UK) to replace the ascending aorta for a bicuspid aortic valve and ascending aneurysm. Echocardiography showed severe aortic valve regurgitation originating in the area of the noncoronary cusp (Fig. 1). At reoperation, there was a tear in the noncoronary cusp of the Freestyle bioprosthesis (Fig. 2). The cusps were excised, leaving the wall of the Freestyle bioprosthesis in situ. A #23 Freedom Solo stentless bioprosthesis (Sorin SpA., Milano, Italy) was implanted. The patient had an uncomplicated postoperative course and was discharged on the eighth postoperative day.