A Case of Left Main Trunk (LMT) Obstruction after Aortic Valve Replacement (AVR) Using Carpentier-Edwards PERIMOUNT MAGNA / 日本心臓血管外科学会雑誌

We reported a 74-year-old female complicated by ostial obstruction of the left main trunk after aortic valve replacement for severe aortic stenosis. At surgery, the length from the orifice of the left main trunk to the aortic annulus was 3 mm. After a 19 mm Carpentier-Edwards PERIMOUNT MAGNA was implanted in supra-annular position, the orifice of left main trunk was concealed by a sewing cuff of the bioprosthesis. Before aortic declamping, saphenous vein graft was bypassed to the left anterior descending artery. The postoperative course was uneventful. Computed tomography demonstrated the ostial obstruction of the left main trunk by the bioprosthesis.

Apicoaortic Conduit Bypass Surgery for Severe Calcific Aortic Valve Stenosis / 日本心臓血管外科学会雑誌

We report a case of a 79-year-old woman who underwent apicoaortic conduit bypass (ACB) surgery for severe calcific aortic valve stenosis. We did not perform conventional aortic valve replacement because of the patient's advanced age and because she had a small aortic annulus (17 mm) and a high risk of bleeding and cerebral infarction. ACB surgery through a left thoracotomy was performed via a femorofemoral bypass. A hand-made valve conduit was made from the left ventricular apex to the descending aorta. Her postoperative course was uneventful ; postoperative echocardiography showed a decreased pressure gradient at the native aortic valve between the left ventricle and the aorta. This procedure is useful in high-risk patients with severe calcified aortic valve stenosis.

Leaflet Extension Aortic Valvuloplasty and Mitral Valve Replacement for Congenital Bicuspid Aortic Stenosis with Severe Mitral Regurgitation in a Child / 日本心臓血管外科学会雑誌

A baby girl with a low birth weight was given a diagnosis of congenital bicuspid aortic stenosis and mitral valve prolapse. At the age of 40 days, she underwent balloon aortic valvotomy, but significant aortic regurgitation appeared afterwards. Another surgical intervention became necessary by the age of 20 months (weight, 5.7 kg), because of intractable heart failure mostly caused by exacerbated mitral regurgitation. We performed a leaflet extension valvuloplasty for the small bicuspid aortic valve using an autologous pericardium treated by glutaraldehyde. The mitral valve was replaced with an ATS-16AP valve. Although her postoperative course was complicated with mitral paravalvular leakage and poor left ventricular function, she was discharged from hospital 6 months post operatevely. Leaflet extension valvuloplasty is a surgical option for infants with a small aortic annulus, but the procedure could be the only solution in cases when Konno or Ross techniques are not suitable.

A Case of Aortic Valve Replacement with a CarboMedics "Top Hat" Supra-annular Aortic Valve in the Calcified Small Aortic Root and Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

A 79-year-old woman with aortic stenosis due to a calcified small aortic root and severe coronary stenosis (at the left anterior descending artery) underwent aortic valve replacement with a 19mm CarboMedics “Top Hat” supra-annular aortic valve and coronary artery bypass grafting. The postoperative course was uneventful. It was found that by using the CarboMedics supra-annular aortic valve, at least one more large sized valve could be implanted compared to the standard aortic valve. This valve is useful in difficult cases to enlarge the narrow aortic annulus, such as in patients with a severe calcified small aortic root, left ventricular dysfunction or elderly cases. In addition, the operative risk may be decreased and operative time shortened using this valve.