A Case of Aortic Regurgitation Accompanied by Multiple Metal Allergy Treated with Aortic Valve Replacement under Median Sternotomy

(Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan)

Shinya Takimoto Michiya Hanyu Yoshio Arai
Atsushi Nagasawa Akiyoshi Mikuriya Takeichiro Nakane
Hiroo Teranishi Shun Watanabe Takashi Tsuji
A 58-year-old man who complained of dyspnea on effort was given a diagnosis of decompensated congestive heart failure. Echocardiography revealed severe aortic regurgitation and cardiomegaly. We decided to perform aortic valve replacement with a mechanical valve, however his past history made us suspicious of allergy to metal. From his previous patient records, we determined he was allergic to many metals:gold, iron, platinum, cobalt, chrome, bronze, and zinc. Newly performed skin patch tests showed positive reactions to aluminum, tin, palladium, indium, iridium and stainless steel. We selected a CarboMedics mechanical valve made of nickel-titanium alloy. Aortic valve replacement with a 27-mm CarboMedics mechanical valve was performed by median sternotomy. At sternum closure, we used polyester non-absorbable suture thread, instead of surgical steel wire, because it contains stainless steel. His postoperative progress was good and he was discharged on the 10th postoperative day. One year after surgery he is doing well without any allergic symptoms.
  Jpn. J. Cardiovasc. Surg. 42:466-470(2013)

Keywords:metal allergy, mechanical valve, skin patch test