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Aortic Valve Repair for an Aortic Valve Periprosthetic Leakage
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（Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Japan）
| Taishi Fujii |
Tamaki Takano |
Megumi Fuke |
| Kazunoki Komatsu |
Kazuyoshi Otu |
Takamitsu Terasaki |
| Yuko Wada |
Daisuke Fukui |
Jun Amano |
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A 77-year-old man underwent aortic valve replacement with a Carpentier-Edwards Pericardial Magna（19mm）for aortic stenosis. He presented with a low grade fever and congestive heart failure 6 months after the initial valve replacement. Staphylococcus aureus was detected in blood culture, and peri-valvular leakage was revealed by echocardiography. Prosthetic valve endocarditis was diagnosed and underwent re-aortic valve replacement with Medtronic Mosaic 21mm bioprothesis. Six months after the re-do operation, perivalvular leakage was newly observed between the right and non-coronary cusps, which was opposite to endocarditis affected cusps. The peri-valvular leakage was considered to have resulted from the fragile valve annulus because he did not have fever, and repeated blood culture showed no bacterial growth. We performed a third surgery and repaired the leakage by adding sutures through the right atrium and the interventricular septum to avoid directly suturing the fragile annulus. The post-operative course was uncomplicated, and no sign of endocarditis nor perivalvular leakage was observed during 9-months of observation. It is considered that the aortic valve fixation sutures through the right atrium and inter-ventricular septum are useful alternatives for fragile aortic annulus after prosthetic valve endocarditis.
Jpn. J. Cardiovasc. Surg. 41:262-265（2012）
Keywords：perivalvular leakage, repair, endocarditis
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