Abe T, Kawahito K, Naganuma H, Hanai M, Mashiko K, Hashimoto K
Department of Cardiovascular Surgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan.
Kyobu Geka. 2008 Jul;61(7):545-8.
We report re-do aortic valve and ascending aorta replacements by using the valve-on-valve technique for primary tissue failure of a Freestyle bioprosthesis. A 74-year-old male, who had had a 25 mm Freestyle bioprosthetic valve implanted by the sub-coronary method 5 years previously for aortic valve regurgitation due to congenital bicuspid valve, was referred to our hospital for dyspnea and palpitation. He presented with heart failure secondary to aortic regurgitation due to primary tissue failure, and computed tomography demonstrated an enlarged ascending aorta (5 cm in diameter). The operative findings revealed that the Freestyle bioprosthetic valve had a leaflet tear at the left coronary cusp. We replaced the degenerated Freestyle bioprosthesis with a 19 mm Mosaic aortic bioprosthesis by using the valve-on-valve technique, and ascending aorta replacement was performed simultaneously. This technique can be useful for re-do surgery for degenerated stentless valves to avoid potential risks of complete excision of the bioprosthesis.
我们报告了通过瓣膜内瓣膜技术对Freestyle生物瓣膜原发性组织衰竭进行再次主动脉瓣和升主动脉置换术。一名74岁男性，5年前因先天性二叶式瓣膜导致主动脉瓣反流，采用冠状动脉下法植入了一枚25mm的Freestyle生物瓣膜，因呼吸困难和心悸转诊至我院。他因原发性组织衰竭继发主动脉瓣反流而出现心力衰竭，计算机断层扫描显示升主动脉增宽（直径5cm）。手术发现Freestyle生物瓣膜左冠状动脉瓣叶有撕裂。我们采用瓣膜内瓣膜技术用一枚19mm的Mosaic主动脉生物瓣膜替换了退化的Freestyle生物瓣膜，并同时进行了升主动脉置换。该技术对于退化的无支架瓣膜再次手术可能有用，可避免生物瓣膜完全切除的潜在风险。
