Leaflet Perforation Using Cor-Knot in Minimally Invasive Aortic Valve Replacement.

A 38-year-old woman underwent minimally invasive aortic valve replacement with a 21-mm Inspiris aortic valve and Cor-Knot for type 0 bicuspid valve and severe aortic stenosis. Postoperative transthoracic echocardiography was uneventful. Four months later, she experienced shortness of breath. Transthoracic echocardiography revealed moderate to severe aortic valve regurgitation, and prosthetic valve dysfunction was suspected. Aortic valve reoperation through a median sternotomy was performed. The bioprosthetic valve was perforated at the noncoronary cusp valve site, probably because of prolonged exposure to the Cor-Knot. When Cor-Knot is used in a narrow space, a perpendicular apposition should always be maintained between the sewing ring and the Cor-Knot tips.